Celecoxib (Celebrex®) versus Meloxicam (Mobic®)

Difference between Celecoxib and Meloxicam
 
Celecoxib
Meloxicam
Brand name/Year of initial approval Celebrex®, 1998 Mobic®, 2000
Formulations oral capsules oral tablets, oral suspension
Drug class Cyclooxygenase-2 (COX-2) selective non-steroidal anti-inflammatory drugs (NSAIDs)
Meloxicam is less selective for COX-2 than celecoxib
Phenylpyrazole Oxicam derivative, a member of the enolic acid group of NSAIDs
Legal status Non-controlled substance
(no potential for addiction)
Prescription only
FDA-approved Indications • Osteoarthritis
• Rheumatoid arthritis in adults
• Juvenile rheumatoid arthritis in patients 2 years and older
• Ankylosing spondylitis
• Primary dysmenorrhea
• Adenomatous colorectal polyps
• Osteoarthritis
• Rheumatoid arthritis
• Juvenile rheumatoid arthritis in patients 2 years of age and older
Mechanism of action Nonsteroidal anti-inflammatory drug with anti-inflammatory, analgesic, and antipyretic activities. Produces analgesic effects by blocking the production of prostaglandins, necessary for the processing of pain information.
Onset of action within 1 hour within 1 hour
Duration of action up to 8 hours up to 24 hours
Half-life 11 hours 18 - 20 hours
Oral bioavailability 40%4 89%
Metabolism, Elimination Hepatic metabolism via CYP2C9. About 57% is excreted in the feces and 27% in the urine. Hepatic metabolism via CYP2C9, almost completely metabolized to 4 pharmacologically inactive metabolites. Most of meloxicam is excreted in the form of metabolites in urine and feces.
Contraindications • Hypersensitivity to celecoxib
• Allergic-type reactions to sulfonamides
• Hypersensitivity to meloxicam
• History of asthma, urticaria, or allergic reactions after taking aspirin or other NSAID
• Peri-operative pain in the setting of coronary artery bypass graft surgery
Warnings & precautions • Cardiovascular effects
• Risk of GI ulceration, bleeding, and perforation
• Renal toxicity

Meloxicam has lower risk of myocardial, vascular and renal risks than celecoxib 3
Side effects • Selective NSAIDs are safer for gastrointestinal tract, but more frequently cause cardiovascular side effects.
• There is evidence 7 that patients taking celecoxib are less likely to experience either GI adverse events or complicated upper GI conditions than those taking meloxicam.
• Celecoxib significantly decreases urinary sodium and potassium excretion compared with meloxicam9.
Abuse potential No
Drug interactions • Fluconazole
• Cholestyramine
• Furosemide
• ACE inhibitors
• Lithium
• Celecoxib can be used with low-dose aspirin 1 • Concomitant use with aspirin is not generally recommended 2. However, clinicl data shows good compatibility with low-dose aspirin 6.
Pregnancy category C C (prior to 30 weeks gestation)
D (after 30 weeks gestation, may cause premature closure of the ductus arteriosus)

Currently there are NO published head-to-head clinical comparisons between celecoxib and meloxicam.

Both celecoxib and meloxicam are effective and have similar benefits and risks. They do work a little differently. Celecoxib is the most selective inhibitor of COX-2 of available NSAIDs. Meloxicam preferentially inhibits COX-2 over COX-1 at low doses (7.5 mg/day), however loses this property at high doses.

Both meloxicam 6 and celecoxib 5 do not block the effect of low dose aspirin.

Both have low ulcerogenic potency relative to other NSAIDs. Celecoxib seems to be more safe with regard to risk of GI complications 7.

The major advantage of meloxicam is its convenient once-daily dosing regimen.

Effectiveness: The effectiveness rates in the treatment of rheumatoid arthritis are 67.6% for meloxicam and 69.1% for celecoxib 8.

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Further reading

References
  • 1. Prescribing Information for CELEBREX ® (celecoxib) PDF
  • 2. Prescribing Information for Mobic® (meloxicam) PDF
  • 3. Asghar W, Jamali F. The effect of COX-2-selective meloxicam on the myocardial, vascular and renal risks: a systematic review. Inflammopharmacology. 2015 Feb;23(1):1-16. PubMed
  • 4. Guzmán HR, Tawa M, Zhang Z, et al. Combined use of crystalline salt forms and precipitation inhibitors to improve oral absorption of celecoxib from solid oral formulations. J Pharm Sci. 2007 Oct;96(10):2686-702.
  • 5. Wilner KD, Rushing M, Walden C, Adler R, Eskra J, Noveck R, Vargas R. Celecoxib does not affect the antiplatelet activity of aspirin in healthy volunteers. J Clin Pharmacol. 2002 Sep;42(9):1027-30. PubMed
  • 6. Van Ryn J, Kink-Eiband M, Kuritsch I, Feifel U, Hanft G, Wallenstein G, Trummlitz G, Pairet M. Meloxicam does not affect the antiplatelet effect of aspirin in healthy male and female volunteers. J Clin Pharmacol. 2004 Jul;44(7):777-84. PubMed
  • 7. Layton D, Hughes K, Harris S, Shakir SA. Comparison of the incidence rates of selected gastrointestinal events reported for patients prescribed celecoxib and meloxicam in general practice in England using prescription-event monitoring data. Rheumatology (Oxford). 2003 Nov;42(11):1332-41. PubMed
  • 8. Shi W, Wang YM, Li LS, Yan M, Li D, Chen NN, Chen BY. Safety and efficacy of oral nonsteroidal anti-inflammatory drugs in patients with rheumatoid arthritis : a six-month randomised study. Clin Drug Investig. 2004;24(2):89-101. PubMed
  • 9. Harirforoosh S, Aghazadeh-Habashi A, Jamali F. Extent of renal effect of cyclo-oxygenase-2-selective inhibitors is pharmacokinetic dependent. Clin Exp Pharmacol Physiol. 2006 Oct;33(10):917-24. PubMed

Published: December 16, 2015
Last updated: March 28, 2016

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