Meloxicam vs. Naproxen for Pain

Meloxicam (sold under the brand name Mobic) is a prescription-only nonsteroidal anti-inflammatory drug (NSAID) for treating pain related to arthritis in adults and children 2 years old and older.

Naproxen is another NSAID, and it is approved for distribution as a prescription (sold as Naprosyn) and an over-the-counter (OTC) drug (sold as Aleve).

Meloxicam is considered more potent than naproxen and has a longer-lasting effect. As a result, meloxicam can be taken in smaller doses and less frequently than naproxen.

Naproxen, on the other hand, is dosed multiple times daily and is available in slow-release formulations. These slow-release formulations are designed to release the drug into the body at slower rates, prolonging its effects.

Meloxicam's risk of GI side effects is lower compared to naproxen. However, it does have a higher risk of heart-related effects. Other NSAIDs, like naproxen, may be preferred if you have any GI risk or high cardiovascular risk.

This article compares the similarities and differences of meloxicam and naproxen.

What Is Meloxicam?

Meloxicam is an NSAID used to relieve various types of pain. It is used to treat osteoarthritis or rheumatoid arthritis in adults and juvenile rheumatoid arthritis in children at least 2 years old. It is available as tablets and capsules.

How Does It Work?

Meloxicam inhibits COX-1 and COX-2, the enzymes that produce prostaglandins.

Prostaglandins are responsible for producing pain and inflammation. Specifically, COX-1 protects the stomach lining, promotes blood clotting, and aids in kidney function, while COX-2 is involved in the body's inflammatory response.

Meloxicam preferentially inhibits COX-2 over COX-1 at low doses, such as 7.5 milligrams (mg). This means that it can reduce pain and inflammation without irritating the stomach lining or increasing the risk of stomach ulcers. However, if the dosage of meloxicam is increased to 15 mg, it will inhibit COX-1, which may increase its risk of GI side effects.

What Is Naproxen?

Naproxen is also an NSAID, and it is approved for prescription and OTC use. The prescription formulation is marketed under Naprosyn and EC-Naprosyn (delayed-release formulation). OTC naproxen is sold under the brand name Aleve.

Prescription naproxen is used to treat pain or inflammation caused by conditions such as:

• Rheumatoid arthritis
• Osteoarthritis
• Ankylosing spondylitis
• Polyarticular juvenile idiopathic arthritis
• Tendonitis
• Bursitis
• Gout
• Menstrual cramps

The delayed-release tablets are slower-acting naproxen forms used only for treating long-term conditions such as arthritis or ankylosing spondylitis. They will not work fast enough to treat acute pain (sudden or urgent).

Naproxen is also available in combination with sumatriptan, a type of selective serotonin receptor agonist, to treat migraines, and in combination with esomeprazole to lower the risk of developing gastric ulcers.

Naproxen sodium is also marketed as an OTC product, Aleve, for reducing pain, inflammation, or fever in those 12 and older. Plus, it's available in combination with diphenhydramine in Aleve PM  and with pseudoephedrine in Aleve-D Sinus & Cold.

How Does It Work?

Naproxen is a nonselective inhibitor of COX-1 and COX-2. It works by reducing prostaglandin synthesis.

Meloxicam vs. Naproxen: Which Is Stronger?

Meloxicam and naproxen are both effective pain relievers. However, meloxicam is considered more potent and longer-lasting than naproxen

In one clinical study involving adults with rheumatoid arthritis, meloxicam was just as effective as naproxen. It was also better tolerated, with a significantly lower incidence of Gl and kidney side effects.

In another randomized, double-blind clinical trial in children with juvenile idiopathic arthritis, the short- and long-term safety and efficacy of meloxicam was comparable with the safety and efficacy of naproxen

Overall, the choice between meloxicam and naproxen will depend on your specific condition, medical history, and other factors. Consult your healthcare provider to determine the most suitable option for you.

How to Take Meloxicam and Naproxen

Can You Take Meloxicam and Naproxen Together?

Avoid taking naproxen and meloxicam together as combining may increase the risk or severity of side effects like:

• Stomach ulcers
• Perforation
• Stomach bleeding
• High blood pressure
• High potassium
• Kidney dysfunction

Safety and Side Effects

Common Side Effects

Some common side effects of meloxicam are:

• Anemia (with long-term use)
• Diarrhea
• Fever
• Flu-like symptoms
• Hives
• Itching
• Upper respiratory infection
• Urinary tract infection
• Vomiting

A common side effect of naproxen is shortness of breath.

Shared common side effects of both medications include:

• Abdominal pain
• Constipation
• Delayed ovulation
• Dizziness
• Drowsiness
• Elevated liver enzymes
• Headache
• Indigestion
• Sensitivity to sunlight
• Nausea
• Rash
• Ringing ears
• Swelling/fluid retention
  

Severe Side Effects

Meloxicam and naproxen can sometimes cause the following potentially severe side effects:

• Allergic reactions
• Blood clots or other blood disorders, such as anemia
• Elevated potassium levels (hyperkalemia)
• Eosinophilia (reaction that causes elevated eosinophils, a type of white blood cell, in the bloodstream)
• Edema
• Heart attack or heart failure
• High blood pressure (hypertension)
• Inflammation of the pancreas
• Kidney disorders, such as kidney failure or renal papillary necrosis (a type of kidney damage)
• Liver failure
• Skin disorders, such as Stevens-Johnson syndrome (a severe disorder that causes painful blisters and lesions on the skin and mucous membranes and can cause eye problems), exfoliative dermatitis (severe inflammation of the entire skin surface), or toxic epidermal necrolysis (a life-threatening skin disorder characterized by a blistering and peeling of the skin)
• Stomach bleeds, perforation, and/or ulcers
• Stroke
• Wheezing

Meloxicam can also potentially cause aseptic meningitis (a condition causing inflammation of the brain lining).

The following conditions have also been associated with naproxen:

• Low blood platelet count
• Low neutrophils (a type of white blood cell)
• Low number of granulocytes (a type of white blood cell)
• Low red blood cells
• Low white blood cells
  

Other Precautions

Like all NSAIDs, meloxicam's and naproxen’s labeling both carry boxed warnings. These warnings from the Food and Drug Administration (FDA) highlight the significant risks of a potentially dangerous medication.

NSAIDs can cause serious side effects, including heart-related (cardiovascular) risks and GI bleeding.

Cardiovascular Risks

Taking meloxicam or naproxen may increase the risk of heart attack or stroke. These can occur anytime, but the risk is higher for those taking high doses or taking the medication long term.

Avoid taking either of these medications if you have recently had a heart attack, and tell your healthcare provider of any history of heart disease or other health conditions.

Gastrointestinal Bleeding

Taking meloxicam or naproxen may increase the risk of tears, ulcers or bleeding in the esophagus, stomach, or intestines. These events can occur at any time during use.

The risk increases with the following:

• History of stomach ulcers, or stomach or intestinal bleeding with the use of NSAIDs
• Taking medicines called corticosteroids, blood thinners, selective serotonin reuptake inhibitors (SSRIs), or serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Increasing doses of NSAIDs, taking them long term, or taking other drugs containing NSAIDs
• Smoking
• Having three or more alcoholic drinks every day
• Being age 60 or older
• Having advanced liver disease
• Poor health

Do not take NSAIDs right before or after a heart surgery called a coronary artery bypass graft (CABG).

Before taking NSAIDs, inform the prescribing provider of all of your medical conditions, including if you:

• Have liver or kidney problems
• Have high blood pressure
• Have asthma
• Are pregnant or plan to become pregnant
• Are breastfeeding or plan to breastfeed

Tell your healthcare provider about the other medicines you take, including prescription or OTC medicines, vitamins, or herbal supplements. NSAIDs and some other medicines can interact with each other and cause serious side effects. Do not start taking new medications without talking to your healthcare provider first.

Who Shouldn’t Take Meloxicam or Naproxen?

Do not take meloxicam under the following circumstances:

• If you are allergic to meloxicam
• If you have had an asthma attack, hives, or other allergic reaction to aspirin or any other NSAIDs
• Right before or after CABG
• If you’re 30 or more weeks pregnant
• If you have phenylketonuria (a rare disorder in which the amino acid phenylalanine builds up in the body)

Do not take naproxen under the following circumstances:

• If you are allergic to naproxen
• If you have had an asthma attack, hives, or other allergic reaction to aspirin or any other NSAIDs
• Right before or after CABG
• If you’re 30 or more weeks pregnant
• If you have advanced kidney disease
  

Drug Interactions

Both meloxicam and naproxen may interact with the following:

• Ketorolac: Taking this with meloxicam or naproxen may increase the risk of adverse effects as all of these medications are NSAIDs
• Drugs that can impact bleeding (e.g., warfarin, aspirin, SSRIs/SNRIs): Combining these drugs with naproxen or meloxicam may increase the risk of bleeds. If you must take them together, your healthcare provider will monitor you for bleeding.
• Beta-blockers or diuretics: Taking meloxicam or naproxen with these drugs may affect their blood pressure–lowering effect. If you must take them together, your healthcare provider will have you monitor your blood pressure.
• Angiotensin converting enzyme (ACE) Inhibitors and angiotensin II receptor blockers (ARBs): Taking meloxicam or naproxen with these drugs may affect their blood pressure–lowering effect. If you must take them together, your healthcare provider will have you monitor your blood pressure. Combining these drugs may also worsen kidney function in older adults, those who are dehydrated, or those with kidney damage. If you are at high risk, your healthcare provider will monitor you for signs of worsening kidney function.

 Naproxen may also interact with the following:

• Colchicine: Taking naproxen with colchicine may increase colchicine levels and the risk of side effects. Your healthcare provider may recommend an alternative or decrease the colchicine dose during and in the 14 days after naproxen use.
• Digoxin: Taking naproxen with digoxin may increase the digoxin levels in the body, increasing the risk of side effects. If you must take them together, your healthcare provider will monitor your digoxin levels.

Summary

Meloxicam and naproxen are both NSAIDs used to treat pain and inflammation. Meloxicam is considered more potent and longer lasting, requiring lower dosages and less frequent administration.

Meloxicam is also a selective COX-2 inhibitor, reducing the risk of GI side effects compared to naproxen.

However, NSAIDs that are selective COX-2 inhibitors, like meloxicam, have increased cardiovascular risk. NSAIDs like naproxen may be preferred in people with low to moderate GI risk and high cardiovascular risk.