Celecoxib (Celebrex®) versus Meloxicam (Mobic®)

Based on "Essential Pain Pharmacology"
written by Howard S. Smith, MD; Marco Pappagallo, MD

Difference between Celecoxib and Meloxicam

Celecoxib	Meloxicam
Brand name/Year of initial approval
• Celebrex®, 1998	• Mobic®, 2000
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
Dose formulations
• Oral capsules	• Oral tablets • Oral suspension
Legal status
• Non-controlled substance (no potential for addiction) • Prescription only
Abuse potential
• No
FDA-approved indications
• Osteoarthritis • Rheumatoid arthritis in adults • Juvenile rheumatoid arthritis in patients 2 years and older • Ankylosing spondylitis (type of arthritis that affects the spine) • Primary dysmenorrhea (menstrual cramps) • Adenomatous colorectal polyps	• Osteoarthritis • Rheumatoid arthritis • Juvenile rheumatoid arthritis in patients 2 years of age and older
"Off-label" uses
• Chronic low back pain (lumbago) Celecoxib alleviates low back pain 10. Back pain may involve neuropathic as well as nociceptive pain mechanisms. In certain cases celecoxib in combination with pregabalin may work better than the NSAID alone 11. Periradicular injection of meloxicam alleviates chronic low back pain, that does not respond to other medications12. • Frozen shoulder (scapulohumeral periarthritis) Meloxicam13 and celecoxib14 reduce pain and inflammation associated with frozen shoulder.
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, because celecoxib contains a sulfonamide moiety.	• 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
• Potential adverse effects on the cardiovascular system. Moderate doses of celecoxib are no more risky than non-selective NSAIDs. • Risk of GI ulceration, bleeding, and perforation • Renal toxicity Meloxicam has lower risk of myocardial, vascular and renal events 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.
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, clinical 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 safer 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.

Further reading

• Non-Steroidal Anti-Inflammatory Drugs
• Meloxicam vs Diclofenac
• Meloxicam vs Ibuprofen

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
• 10. Bedaiwi MK, Sari I, Wallis D, et al. Clinical Efficacy of Celecoxib Compared to Acetaminophen in Chronic Nonspecific Low Back Pain: Results of a Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2016 Jun;68(6):845-52
• 11. Romanò CL, Romanò D, Bonora C, Mineo G.Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain. J Orthop Traumatol. 2009 Dec;10(4):185-91.
• 12. Borghi B, Aurini L, White PF, Mordenti A, Lolli F, Borghi R, Martignani M, Greggi T.Long-lasting beneficial effects of periradicular injection of meloxicam for treating chronic low back pain and sciatica. Minerva Anestesiol. 2013 Apr;79(4):370-8.
• 13. Ogino K, Saito K, Osugi T, Satoh H. Meloxicam (Mobic): a review of its pharmacological and clinical profile. Nihon YakurigakuZasshi. 2002 Dec;120(6):391-7.
• 14. Ohta S, Komai O, Hanakawa H. Comparative study of the clinical efficacy of the selective cyclooxygenase-2 inhibitor celecoxib compared with loxoprofen in patients with frozen shoulder. Mod Rheumatol. 2014 Jan;24(1):144-9

Published: December 16, 2015
Last reviewed: April 04, 2018