Comparing Meloxicam With Ibuprofen

What Is Meloxicam?

Meloxicam (Mobic) is commonly used to treat chronic arthritis. The Food and Drug Administration (FDA) approved it for use in the United States in 2000, and it is currently prescribed to over 9 million people each year. Unlike ibuprofen, meloxicam can only be obtained through a doctor’s prescription.¹

Meloxicam is what’s known as a COX inhibitor. It and other NSAID medications work by interfering with cyclooxygenase enzymes to temporarily decrease the production of certain prostaglandin molecules—which play a vital role in our normal inflammatory response to injury and infection but also sensitize us to experiencing pain.²

The drug has anti-inflammatory and analgesic (pain-relieving) properties. Specific uses of meloxicam include treating pain, swelling, and tenderness associated with various forms of arthritis, such as osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis. In general, meloxicam is taken once daily in tablet or liquid suspension form.³

What Is Ibuprofen?

Ibuprofen is the primary active component of several brand-name medications such as Motrin, Advil, and Midol. It can also be found as an ingredient in combination drugs such as Advil PM (with diphenhydramine) and, until relatively recently, was combined with opioid painkillers such as oxycodone (Combunox) and hydrocodone (Vicoprofen).⁴

Ibuprofen is an easily accessible drug that can be purchased at your local pharmacy without a doctor’s prescription, though prescription formulations exist as well. It is used to treat a number of conditions, including:⁵

• Fever.
• Mild to moderate pain.
• Rheumatoid arthritis and osteoarthritis.
• Gout.
• Primary dysmenorrhea (menstrual cramps).
• Patent ductus arteriosus, a neonatal condition that can cause heart failure in infants.

Like meloxicam, ibuprofen has anti-inflammatory and pain-relieving effects. Like meloxicam, it also decreases the synthesis of prostaglandins, which helps to reduce inflammation, pain, fever, and swelling.⁵

Ibuprofen is a widely favored painkiller because it is well tolerated by most people and considered to be one of the safest NSAIDs available. It was approved for use via prescription in the U.S. in 1974 and made available over the counter in 1984. More than 20 million prescriptions for ibuprofen are filled each year, which does not account for how many people purchase the drug at their local pharmacies.⁶

Because ibuprofen is not as long-acting as meloxicam, it is taken 3 or 4 times per day for arthritis and every 4 to 6 hours as needed for pain. Prescription ibuprofen is most commonly administered in oral tablet form. Nonprescription ibuprofen is available in a range of formulations including oral capsule/tablets, chewable tablet, and as a liquid suspension.⁴

What Are the Side Effects of These Drugs?

As they are both NSAIDs and COX inhibitors, meloxicam and ibuprofen have many of the same potential side effects.  Though these medications are generally well tolerated, some potential side effects include:^1,4,6,7

• Nausea.
• Stomach upset.
• Heartburn.
• Diarrhea.
• Headache.
• Ringing in the ears.
• Dizziness.
• Drowsiness.
• Itching.

A few of the less common but more serious side effects that can occur from taking meloxicam or ibuprofen include:^4,7

• Peripheral edema (buildup of fluid in the legs and hands that causes swelling).
• Hypersensitivity (i.e., allergic) reactions such as bronchoconstriction, fever, hives, rash, blisters.
• Hepatocellular injury, liver damage, and resulting yellowing of the skin or eyes.
• Cloudy or discolored urine.
• Impaired renal function.
• Renal necrosis.
• Back pain.
• Painful urination.
• Flu-like symptoms.

In addition, NSAIDs can increase the risk of blood clots, heart attack, and stroke. The risk increases the longer someone takes these drugs. They may also increase the risk for gastrointestinal ulceration, bleeding, and perforation.⁸

Which Drugs Do They Interact With?

Meloxicam and ibuprofen can interact with other medications you might be taking. Some drugs that can potentially interact with NSAIDs include:

• Warfarin—when used with meloxicam, may increase the risk of bleeding.
• Aspirin—increased risk of gastrointestinal bleeding when used with meloxicam.
• Lithium—both meloxicam and ibuprofen can increase lithium plasma levels in the blood, raising the risk of lithium toxicity.
• ACE-inhibitors, thiazides, loop diuretics—NSAIDs may reduce the diuretic and/or antihypertensive effect of these drugs.
• Sodium polystyrene sulfonate—may increase the risk of intestinal necrosis (blockage of arteries in the intestine) when taken with sorbitol-containing meloxicam oral solution.^3,8

Ibuprofen may also interact with the following drugs:⁸

• Diuretics—may be less effective when taken with ibuprofen
• Methotrexate—NSAIDs may reduce methotrexate elimination, leading to an increased risk of toxicity when both medications are used together

Can You Overdose?

Overdose on meloxicam and/or ibuprofen is possible. Overdose can occur when an individual consumes a toxic amount of a medication—either accidentally or intentionally.

In the event of an overdose, emergency medical help may be needed. There is no antidote for NSAID toxicity. Depending on the severity of the overdose, the individual in question may receive a number of different supportive treatments.

In the emergency room, medical staff will closely supervise the person and monitor their vital signs. IV fluids may be administered, especially if there is excessive vomiting and dehydration. If the person is significantly acidotic, fluid resuscitation with IV bicarbonate may be necessary. In some cases, the individual may need breathing support, such as through a breathing tube or ventilator.^9,10

Additional tests can be done, including blood and urine tests, as well as checks for internal bleeding. An electrocardiogram (EKG) may be conducted to assess any impacts the overdose had on the heart. Likewise, a chest X-ray may be taken. Finally, doctors may use medications to treat any remaining symptoms (e.g., benzodiazepines if there are seizures/convulsions).⁹

Luckily, recovery from an ibuprofen or meloxicam overdose is likely with medical care. However, lasting liver and kidney injury is possible.⁹

Possibility of Abuse

Meloxicam and ibuprofen are not controlled substances, are not associated with physical dependence, nor will they lead to abuse or addiction. But there is still a risk of misuse.

Some people simply take too much of the drug, often to manage their pain. A 2018 study found that out of 1,326 adults, over 15% exceeded the recommended maximum daily dose for NSAIDs over a one-week period. People who were most likely to exceed the daily limit suffered from chronic pain.¹¹

Other people may deliberately overdose in an attempt at suicide. A case study in 2006 documented an incident where a 26-year-old woman died after ingesting 132 tablets of 800mg sustained-release ibuprofen. The study reported 9 known fatalities from ibuprofen overdose at the time.¹²

Finally, some people may abuse combination analgesics (e.g., ibuprofen and hydrocodone), seeking a euphoric high. A 2004 study presented the case of a person who developed hypokalemia (low potassium levels in the blood) after abusing Nurofen Plus, a foreign combination product containing ibuprofen and codeine. The study’s authors suggested that this type of ibuprofen abuse may be more common than medical professionals previously thought.¹³

In conclusion, ibuprofen and meloxicam can be effective in the treatment of pain and joint inflammation. But they do come with risks—side effects, overdose, and medical complications—that users should be aware of.

Find Substance Abuse Treatment Near You

Sources

1. National Institutes of Health, LiverTox. (2018). Meloxicam.
2. DrugBank. Meloxicam.
3. Food and Drug Administration. (2012). Mobic.
4. U.S. National Library of Medicine, Medline. (2016). Ibuprofen.
5. DrugBank. Ibuprofen.
6. National Institutes of Health, LiverTox. (2018). Ibuprofen.
7. U.S. National Library of Medicine, Medline. (2016). Meloxicam.
8. Food and Drug Administration. (2007). Motrin.
9. U.S. National Library of Medicine, Medline. (2017). Ibuprofen overdose.
10. Hunter, L., Wood, D., and Dargan, P. (2011). The patterns of toxicity and management of acute nonsteroidal anti-inflammatory drug (NSAID) overdose. Open Access Emergency Medicine, 3, 39-48.
11. Siemaszko, C. (2018). Americans are abusing over-the-counter drugs as well as opioids, study shows. NBC News.
12. Wood, D., Monaghan, J., Streete, P., Jones, A., and Dargan, P. (2006). Fatality after deliberate ingestion of sustained-release ibuprofen: a case report. Critical Care, 10(2), R44.
13. Dyer, B., Martin, J., Mitchell, J., and Sauven, N. (2004). Hypokalaemia in ibuprofen and codeine phosphate abuse. International Journal of Clinical Practice, 58(11), 1061-1062.