Ibuprofen vs. Meloxicam (Mobic) for Pain

• Ibuprofen (Advil, Motrin, and others) and meloxicam (Mobic) are nonsteroidal anti-inflammatory drugs (NSAIDs) used for the management of mild to moderate pain, fever, and inflammation.
• Common side effects of meloxicam and ibuprofen that are similar include:
  • Rash
  • Ringing in the ears (tinnitus)
  • Headaches
  • Dizziness
  • Drowsiness
  • Abdominal pain
  • Nausea
  • Diarrhea
  • Constipation
  • Heartburn
• Serious side effects of ibuprofen and meloxicam that are similar include fluid retention (edema), blood clots, heart attacks, high blood pressure (hypertension), and heart failure.
• Both ibuprofen and meloxicam may interact with lithium (Lithobid, Eskalith), blood pressure medications, methotrexate (Rheumatrex, Trexall), aminoglycosides, anticoagulants, cyclosporine, furosemide (Lasix), and thiazide diuretics.
• Taking ibuprofen, meloxicam, or other NSAIDs and consuming more than three alcoholic beverages per day may increase the risk of developing stomach ulcers.
• Taking ibuprofen or meloxicam with selective serotonin reuptake inhibitors (SSRIs) may increase the likelihood of gastrointestinal bleeding.
• Meloxicam is available under the brand name Mobic. Brand names of ibuprofen include Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, and PediaCare Fever.

Ibuprofen (Advil, Motrin) and meloxicam (Mobic) belong to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Other members of this class include indomethacin (Indocin), nabumetone (Relafen), and several others. These drugs are used for the management of mild to moderate pain, fever, and inflammation. NSAIDs work by reducing the levels of prostaglandins, chemicals that are responsible for pain, fever, and inflammation.

Ibuprofen and meloxicam block the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower concentrations of prostaglandins. Consequently, inflammation, pain, and fever are reduced.

Ibuprofen uses

Ibuprofen is used for the treatment of mild to moderate pain, inflammation and fever caused by many and diverse diseases. It is used for treating menstrual cramps (dysmenorrhea), osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis.

Meloxicam uses

Meloxicam is used to treat tenderness, swelling, and pain caused by the inflammation of osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis in patients 2 years of age or older.

The most common side effects from ibuprofen are:

• rash,
• ringing in the ears,
• headaches,
• dizziness,
• drowsiness,
• abdominal pain,
• nausea,
• diarrhea,
• constipation, and
• heartburn.

NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury.

Ibuprofen may cause ulceration of the stomach or intestine, and the ulcers may bleed. Sometimes, ulceration can occur without abdominal pain; and due to bleeding, the only signs or symptoms of an ulcer may be black, tarry stools, weakness, and dizziness upon standing (orthostatic hypotension).

Sometimes, ulceration can occur without abdominal pain, due to the bleeding, and the only signs or symptoms of an ulcer are:

• black, tarry stools,
• weakness, and
• dizziness upon standing (orthostatic hypotension).

NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients who already have impaired function of the kidney or congestive heart failure, and use of NSAIDs in these patients should be cautious.

People who are allergic to other NSAIDs, including aspirin, should not use ibuprofen.

Individuals with asthma are more likely to experience allergic reactions to ibuprofen and other NSAIDs.

Other serious side effects associated with NSAIDs are:

• fluid retention (edema),
• blood clots,
• heart attacks,
• hypertension (high blood pressure), and
• heart failure.

NSAIDs (except low- dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions in people with or without heart disease or risk factors for heart disease. The increased risk of heart attack or stroke may occur as early as the first week of use and the risk may increase with longer use and is higher in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

WARNING

• Individuals who are allergic to NSAIDs may experience shortness of breath when given an NSAID. People with asthma also are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.
• New onset or worsening of high blood pressure (hypertension) may occur. Blood pressure should be monitored closely during treatment.
• Meloxicam may cause fluid retention and swelling (edema). It should be used cautiously in people with heart failure.
• Meloxicam may reduce kidney function. Therefore, it should not be used in people with severe kidney failure. It should be used cautiously in the elderly, people with heart failure, liver dysfunction, and those taking diuretics, ACE-inhibitors, or angiotensin II antagonists.
• Serious skin reactions such as exfoliative dermatitis, Stevens- Johnson syndrome, and toxic epidermal necrolysis (TEN) may occur without warning.
• NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions in people with or without heart disease or risk factors for heart disease. The increased risk of heart attack or stroke may occur as early as the first week of use and the risk may increase with longer use and is higher in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.
• Central nervous system effects including drowsiness, dizziness, and blurred vision may occur in patients who are taking an NSAIDs.

Common side effects with NSAIDs are related to the gastrointestinal tract (GI) and include:

• nausea,
• vomiting,
• abdominal pain,
• diarrhea, and
• gas.

To prevent these common side effects, it is recommended that most NSAIDs be taken with food or milk. NSAIDs may cause ulcers in the stomach and/or small intestine. A few NSAIDs are designed to be less damaging to the stomach and small intestine, therefore; they may be taken with or without food. Meloxicam is an example of one of these NSAIDs, but nevertheless, it should be taken cautiously without food. NSAIDs have been associated with an increased risk of blood clots that can cause strokes and heart attacks. NSAIDs also may interfere with the function of the kidneys or injure the kidneys.

Other important side effects of meloxicam are:

• headache,
• fatigue related to anemia (low red blood cell count),
• joint pain,
• back pain,
• insomnia,
• itching,
• skin rash,
• bladder infection, and
• upper respiratory tract infection.

Ibuprofen dosage

• For minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is 200 or 400 mg every 4 to 6 hours.
• Arthritis is treated with 300 to 800 mg 3 or 4 times daily.
• When under the care of a physician, the maximum dose of ibuprofen is 3.2 g daily. Otherwise, the maximum dose is 1.2 g daily.
• Individuals should not use ibuprofen for more than 10 days for the treatment of pain or more than 3 days for the treatment of a fever unless directed by a physician.
• Children 6 months to 12 years of age usually are given 5-10 mg/kg of ibuprofen every 6-8 hours for the treatment of fever and pain. The maximum dose is 40 mg/kg daily.
• Juvenile arthritis is treated with 20 to 40 mg/kg/day in 3-4 divided doses.
• Ibuprofen should be taken with meals to prevent stomach upset.

Meloxicam dosage

The lowest effective dose should be used for each patient. Meloxicam therapy usually is started at 7.5 mg daily. Some patients require a dose of 15 mg daily, but this larger dose should be taken only under the direction of a physician. Juvenile rheumatoid arthritis is treated with 0.125 mg/kg daily up to 7.5 mg per day. Meloxicam may be taken with or without food.

Ibuprofen drug and alcohol interactions

Ibuprofen is associated with several suspected or probable interactions that can affect the action of other drugs.

• Ibuprofen may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
• Ibuprofen may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure.
• When ibuprofen is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
• Ibuprofen increases the negative effect of cyclosporine on kidney function.
• Individuals taking oral blood thinners or anticoagulants, for example, warfarin (Coumadin), should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding.
• If aspirin is taken with ibuprofen there may be an increased risk for developing an ulcer.
• Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking ibuprofen or other NSAIDs.
• Combining SSRIs or selective serotonin reuptake inhibitors (for example, fluoxetine [Prozac], citalopram [Celexa], paroxetine [Paxil, Paxil CR, Pexeva) with NSAIDs may increase the likelihood of upper gastrointestinal bleeding.

Meloxicam drug and alcohol interactions

• Meloxicam may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
• Meloxicam may reduce the blood pressure-lowering effects of drugs given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure.
• When meloxicam is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
• Meloxicam increases the negative effect of cyclosporine on kidney function and reduces the effect of furosemide (Lasix) and thiazide diuretics because of prostaglandin inhibition.
• Individuals taking oral blood thinners, for example, warfarin (Coumadin, Jantoven), should avoid meloxicam because meloxicam also thins the blood, and excessive blood thinning may lead to bleeding.
• Meloxicam should be avoided by patients with a history of asthma attacks, hives, or other allergic reactions to aspirin or other NSAIDs. If aspirin is taken with meloxicam there may be an increased risk for developing a gastrointestinal ulcer.
• Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking meloxicam or other NSAIDs.
• Cholestyramine (Questran), colestipol (Colestid), and colesevelam (Welchol) may decrease the effectiveness of meloxicam by preventing its absorption from the intestine.
• Meloxicam oral suspension contains sorbitol. Combining sodium polystyrene sulfonate (Kayexalate) with sorbitol may cause fatal intestinal necrosis. Therefore, meloxicam oral solution should not be combined with Kayexalate.

Ibuprofen safety

• There are no adequate studies of ibuprofen in pregnant women. Therefore, ibuprofen is not recommended during pregnancy. Ibuprofen should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus in the fetal heart.
• Ibuprofen is excreted in breast milk but the American Academy of Pediatrics states that ibuprofen is compatible with breastfeeding.

Meloxicam safety

• There have been no studies of meloxicam therapy in pregnant women. Meloxicam generally should be avoided during the first and second trimester of pregnancy. Because meloxicam may cause a fetal birth defect called ductus arteriosus (early closure of two major blood vessels of the heart and lung) in the third trimester of pregnancy, meloxicam also should be avoided during this last part of pregnancy.
• There have been no studies in humans to determine if meloxicam is excreted in breast milk.