Meloxicam vs. Indomethacin

See how Meloxicam and Indomethacin compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Meloxicam is taken once a day, while indomethacin usually needs two to four doses a day, with the dose adjusted weekly.

  • Both drugs carry the same FDA boxed warnings for heart attack, stroke, and stomach bleeding, and neither is approved for use around bypass surgery.

  • Indomethacin is FDA-approved for gout flares and bursitis that meloxicam does not cover, while only meloxicam is approved for juvenile rheumatoid arthritis.

Meloxicam vs. Indomethacin Drug Summary

Meloxicam

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that acts with some preference for the COX-2 enzyme at typical doses. It is FDA-approved to relieve pain and swelling from osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis in children 2 and older. It comes in tablet, dissolving tablet, capsule, liquid, and IV forms, and only needs to be taken once a day.

Indomethacin

Indomethacin is a nonselective NSAID that has been used for decades to relieve pain and swelling from osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout flares, and bursitis or tendinitis. It is taken as a capsule two to four times a day, with the dose adjusted weekly based on how well it is working. A separate IV form is also used for a heart condition in premature infants.

Meloxicam vs. Indomethacin Side Effects

Meloxicam

Most common
Headache (up to 8.3%)
Dyspepsia (up to 4.9%)
URI (up to 6%)
Diarrhea (up to 4.4%)

Indomethacin

Most common
Headache (up to 16%)
Dyspepsia (up to 9%)
Dizziness (up to 9%)
Nausea (up to 9%)

Meloxicam vs. Indomethacin Dosage

Meloxicam

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 7.5 mg once daily At the start
Maximum dose 0.125 mg/kg once daily If needed
Dose changes 2 increases As tolerated

Indomethacin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25 mg 2-3 times daily At the start
Maximum dose Up to 200 mg/day divided If needed
Dose changes 2 increases As tolerated

Meloxicam vs. Indomethacin Indications

Meloxicam

Meloxicam is FDA-approved to relieve pain and stiffness from osteoarthritis and rheumatoid arthritis in adults, plus juvenile rheumatoid arthritis in children 2 and older. It is not approved for use around bypass graft surgery. Some doctors also prescribe it off-label for ankylosing spondylitis or general musculoskeletal pain.

  • Osteoarthritis in adults

  • Rheumatoid arthritis in adults

  • Juvenile rheumatoid arthritis (ages 2+)

  • Off-label: ankylosing spondylitis

  • Off-label: general musculoskeletal pain

Indomethacin

Indomethacin is FDA-approved for moderate to severe osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gouty arthritis, and painful bursitis or tendinitis. It is not approved for use around bypass graft surgery and is generally avoided in children 14 and younger. Off-label, doctors sometimes use it for certain headache disorders or preterm labor.

  • Osteoarthritis (moderate to severe)

  • Rheumatoid arthritis (moderate to severe)

  • Ankylosing spondylitis

  • Acute gouty arthritis

  • Bursitis or tendinitis

Meloxicam vs. Indomethacin Pros and Cons

Meloxicam

Meloxicam's once-daily dosing and COX-2 preference make it a common first NSAID choice for chronic joint pain. Like all NSAIDs, it still carries boxed warnings for cardiovascular and gastrointestinal risks. Insurance coverage and pricing can vary widely by plan and pharmacy.

Pros

  • Only needs to be taken once a day

  • Preferential COX-2 activity may be gentler on the stomach at typical doses

  • Only one of the two approved for juvenile rheumatoid arthritis in kids 2 and up

  • Comes in tablet, dissolving tablet, capsule, liquid, and IV forms

Cons

  • Not approved for gout flares or bursitis and tendinitis

  • Ankylosing spondylitis use is off-label rather than FDA-approved

  • Fixed once-daily dosing is harder to adjust quickly during a sudden flare

Indomethacin

Indomethacin's flexible, frequently adjusted dosing and long track record make it useful for gout flares and acute inflammatory pain that need fast control. It shares the same class-wide boxed warnings as meloxicam. Its multiple daily doses can be harder for some patients to stick with.

Pros

  • FDA-approved for acute gout flares and bursitis or tendinitis

  • On-label approval for ankylosing spondylitis

  • Dose can be adjusted week to week for faster symptom control

  • Decades of clinical use across many inflammatory conditions

Cons

  • Requires two to four doses a day instead of one

  • Nonselective COX inhibition may carry a higher GI irritation risk

  • Generally avoided in children 14 and younger

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