Meloxicam (Mobic®) vs Ibuprofen (Advil®)

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

Difference between Meloxicam and Ibuprofen

Meloxicam	Ibuprofen
• Mobic® • Vivlodex® (low dose formulation)	• Advil®, Advil® PM • Motrin® • Caldolor® • NeoProfen®

Drug class
Non-steroidal anti-inflammatory drugs (NSAIDs)
• Oxicam derivative	• Propionic acid derivative
Dose formulations
• Tablets • Oral suspension	• Tablets • Chewable tablets • Oral suspension • Gel caplets • Liqui-gels • Caplets • Intravenous solution
Legal status
• Non-controlled substance
• Prescription only	• Prescription • Over-the-counter
Abuse potential
• No potential for addiction
FDA-approved indications
• Rheumatoid arthritis • Osteoarthritis
• Juvenile rheumatoid arthritis in patients 2 years of age and older	• Fever • Mild to moderate pain • Dysmenorrhea • Headache, migraine • Patent ductus arteriosus (NeoProfen® only)
"Off-label" uses
• Premedication in dental procedures3 (ibuprofen is slightly more effective) • Renal colic
• Chronic low back pain • Frozen shoulder	• Rheumatic fever • Protection against cataract
Mechanism of action
• Nonsteroidal anti-inflammatory drugs have anti-inflammatory, analgesic, and antipyretic activities. • Analgesic effects are the result of blocking the production of prostaglandins, necessary for processing of pain information.
• Meloxicam preferentially inhibits COX-2 over COX-1.	• Ibuprofen non-selectively inhibits COX-1 and 2 COX-2.
Onset of action
• within 1 hour	• within 30 - 60 minutes • Liqui-gels provide faster onset of pain relief as compared with tablets5.
Duration of action
• up to 24 hours	• 6 hours
Half-life
• 18 - 20 hours	• 2 hours, as the dosage increases, the half-life ranges between 4 and 8 hours
Oral bioavailability
• 89%	• 80-90%
Metabolism, Elimination
• 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.	• 90% of ibuprofen is hepatically metabolized to metabolite A (hydroxyibuprofen) and metabolite B (carboxyibuprofen). • Ibuprofen is almost completely excreted in the urine as unchanged drug and oxidative metabolites.
Contraindications
• Hypersensitivity to meloxicam	• Hypersensitivity to ibuprofen
• 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. • Risk of GI ulceration, bleeding, and perforation. • Renal toxicity.
Side effects
• Meloxicam more frequently causes cardiovascular side effects6.
• See NSAIDs side effects
Pregnancy category
• C (prior to 30 weeks gestation) • D (after 30 weeks gestation, may cause premature closure of the ductus arteriosus)

Meloxicam advantages over Ibuprofen

Meloxicam produces less gastrointestinal side effects compared to ibuprofen.
Meloxicam can be a safe option for patients with hypersensitivity to NSAIDs4.

Ibuprofen advantages over Meloxicam

Low dose ibuprofen is available over-the-counter without a prescription.

Meloxicam vs Ibuprofen for Arthritis

Both medications are indicated for the treatment of rheumatoid arthritis and osteoarthritis.

Effectiveness: The effectiveness rate in the treatment of osteoarthritis and rheumatoid arthritis is 59-77% for meloxicam and 70-83% for ibuprofen 7.

Side effects: The rate of side effects is 4-16% for meloxicam and 15-19% for ibuprofen 7.

References

1. Prescribing Information for Motrin® (ibuprofen) PDF
2. Prescribing Information for Mobic® (meloxicam) PDF
3. Shantiaee Y, Javaheri S, Movahhedian A, Eslami S, Dianat O. Efficacy of preoperative ibuprofen and meloxicam on the success rate of inferior alveolar nerve block for teeth with irreversible pulpitis. Int Dent J. 2017 Apr;67(2):85-90. PubMed
4. Domingo MV, Marchuet MJ, Culla MT, Joanpere RS, Guadaño EM. Meloxicam tolerance in hypersensitivity to nonsteroidal anti-inflammatory drugs. J Investig Allergol Clin Immunol. 2006;16(6):364-6.
5. Lawati HA, Jamali F. Onset of Action and Efficacy of Ibuprofen Liquigel as Compared to Solid Tablets. J Pharm Pharm Sci. 2016 Jul - Sep;19(3):301-311.
6. Dalal D, Dubreuil M, Peloquin C, Neogi T, Zhang Y, Choi H, Felson D. Meloxicam and risk of myocardial infarction: a population-based nested case-control study. Rheumatol Int. 2017 Dec;37(12):2071-2078.
7. Shi W, Wang YM, Cheng NN, Chen BY, Li D. Meta-analysis on the effect and adverse reaction on patients with osteoarthritis and rheumatoid arthritis treated with non-steroidal anti-inflammatory drugs. Zhonghua Liu Xing Bing Xue Za Zhi. 2003

Published: July 21, 2018
Last reviewed: July 21, 2018