As a non‑steroidal anti‑inflammatory drug (NSAID), meloxicam may cause a variety of adverse reactions while effectively relieving the symptoms of arthritis.

I. Side Effects of Meloxicam

1. Common Side Effects

(1) Gastrointestinal reactions: diarrhea, dyspepsia, abdominal pain, nausea, flatulence.

(2) General disorders: influenza-like symptoms, edema.

(3) Nervous system: headache, dizziness.

(4) Respiratory system: upper respiratory tract infection, pharyngitis.

2. Serious Cardiovascular Events

(1) NSAIDs may increase the risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which may lead to death.

(2) The risk may appear early in treatment and increase with longer duration of use.

(3) High‑risk populations include patients with pre-existing cardiovascular disease or risk factors, and patients with recent myocardial infarction.

(4) Meloxicam is contraindicated in the perioperative period of coronary artery bypass grafting.

3. Serious Gastrointestinal Events

Meloxicam may cause gastrointestinal bleeding, ulceration, and perforation, which can be fatal. These events may occur at any time without warning symptoms. Risk factors include:

(1) History of peptic ulcer or gastrointestinal bleeding.

(2) Advanced age (especially frail patients).

(3) Concomitant use of corticosteroids, aspirin, anticoagulants, or SSRIs.

(4) Smoking, alcohol consumption, poor general health, advanced liver disease.

4. Hepatotoxicity

(1) Approximately 1% of patients experience elevations of ALT or AST to more than 3 times the upper limit of normal; fulminant hepatitis, hepatic necrosis, and hepatic failure may occur in rare cases.

(2) Up to 15% of patients may have mild elevations of ALT or AST (less than 3 times the upper limit of normal).

5. Renal-Related Side Effects

(1) Nephrotoxicity: may cause deterioration of renal function, especially in elderly, dehydrated, hypovolemic, or renally impaired patients.

(2) Hypertension: may cause new‑onset hypertension or worsen pre‑existing hypertension.

(3) Heart failure and edema: increases the risk of hospitalization for heart failure and may cause fluid retention and edema.

6. Skin Reactions

(1) Meloxicam may cause severe skin adverse reactions, including exfoliative dermatitis, Stevens‑Johnson syndrome, and toxic epidermal necrolysis, which may be fatal.

(2) Fixed drug eruption may also occur; in severe cases, it may present as generalized bullous fixed drug eruption.

7. Hematologic Side Effects

(1) Anemia: may result from occult or overt blood loss, fluid retention, or effects on erythropoiesis.

(2) Increased bleeding risk: the risk is further increased when combined with anticoagulants, antiplatelet drugs, SSRIs/SNRIs.

8. Other Uncommon Side Effects

(1) General disorders: hypersensitivity reactions, facial edema, fatigue, fever, hot flush, malaise, syncope, weight changes.

(2) Cardiovascular: angina pectoris, heart failure, hypotension, vasculitis.

(3) Psychoneurological: convulsions, paresthesia, tremor, vertigo, abnormal dreams, anxiety, confusion, depression, somnolence.

(4) Respiratory: asthma, bronchospasm, dyspnea.

(5) Special senses: visual disturbances, conjunctivitis, taste perversion, tinnitus.

(6) Urinary system: proteinuria, hematuria, renal failure.

II. Methods to Alleviate Side Effects of Meloxicam

1. Basic Principles of Use

(1) Lowest effective dose, shortest duration: use the lowest effective dose and minimize the duration of treatment according to individual therapeutic goals.

(2) Avoid concomitant use of multiple NSAIDs: combination with other NSAIDs or salicylates is not recommended, as it increases gastrointestinal toxicity without significant improvement in efficacy.

(3) Do not arbitrarily switch formulations: meloxicam tablets are not bioequivalent to other oral meloxicam formulations and cannot be interchanged even at the same milligram strength.

2. Prevention and Control of Cardiovascular Risk

(1) Assess cardiovascular risk before use and remain vigilant during treatment.

(2) Monitor blood pressure, especially at initiation and throughout treatment.

(3) Avoid use in patients with recent myocardial infarction unless the expected benefit outweighs the risk of recurrent cardiovascular events.

3. Methods to Alleviate Gastrointestinal Side Effects

(1) Management of high‑risk patients: consider alternative therapies other than NSAIDs in patients with a history of peptic ulcer or bleeding.

(2) Precautions for combination therapy: when low‑dose aspirin is used concomitantly for cardioprotection, closely monitor for signs of gastrointestinal bleeding.

(3) Prompt management of symptoms: immediately discontinue the drug and initiate evaluation and treatment if a serious gastrointestinal adverse event is suspected.

4. Monitoring of Hepatotoxicity

(1) Inform patients of warning symptoms of hepatotoxicity: nausea, fatigue, somnolence, diarrhea, pruritus, jaundice, right upper abdominal tenderness, influenza-like symptoms.

(2) Discontinue the drug and seek medical attention immediately if these symptoms occur.

(3) Periodically monitor liver function, especially in long‑term users.

5. Renal Protection Measures

(1) Monitoring of high‑risk populations: closely monitor renal function in elderly, dehydrated, hypovolemic, renally impaired, or heart failure patients.

(2) Precautions for combination with antihypertensives: monitor blood pressure and renal function when used concomitantly with ACE inhibitors, ARBs, or diuretics.

(3) Maintain adequate hydration, especially when combined with drugs that may affect renal function.

6. Management of Skin Reactions

(1) Discontinue the drug immediately at the first appearance of rash or other signs of hypersensitivity.

(2) Contraindicated in patients with a history of severe skin reactions to NSAIDs.

7. Management of Special Populations

(1) Elderly: start with a low dose and closely monitor adverse reactions.

(2) Women of childbearing potential: meloxicam may reversibly delay ovulation; consider discontinuation in case of difficulty conceiving.

(3) Asthma patients: contraindicated in aspirin‑sensitive individuals; monitor for changes in asthma symptoms when used in patients without known aspirin sensitivity.

III. Storage Conditions for Meloxicam

1. Temperature Requirements

(1) Storage temperature: 20°C to 25°C (68°F to 77°F).

(2) Permitted excursions: 15°C to 30°C (59°F to 86°F).

2. Humidity Control

(1) Keep in a dry environment.

(2) Avoid moisture to prevent deterioration of the drug.

(3) Store in a tightly closed container.