Meloxicam or Arcoxia?

[Merryroundabout]

Hi, my GP has suggested I try Meloxicam instead of my consultant-prescribed 60mg Arcoxia/Etoricoxib, because even with Omeprazole my tummy feels sore after 3 consecutive days on Arcoxia so I have to pause pain relief. When I was first prescribed Arcoxia 8 years ago on diagnosis of PSA and spondylitis with MRI showing SI joint inflammation it was the first thing that worked for a lengthy very painful flare and it’s been effective since then but I only take it for a few days every 6 weeks or so. My new rheumy saw me when I was feeling well but his parting comment was “do take the tablets” and I’m mindful I want to avoid inflammation causing joint damage. I’ve tried 7 consecutive days Meloxicam back in August and my tummy was fine, which is encouraging, and the effect in my asthma was no worse. However I haven’t had a painful flare to test it against, only niggles which it worked for, so I wondered if anyone here had any experience of the two?

[nomoreheels]

I have. I was prescribed meloxicam after one of my first of 2 NSAIDs earlyish on following diagnosis. I'm currently on etoricoxib, have been for around 9 years now.

My thoughts would be to remain on the meloxicam as they don't cause you gastro or asthmatic problems. See how it fares if/when you have a flare & if they don't cope with it as well as etoricoxib does then that's your answer, a short course of etoricoxib. Both are COX-2 NSAIDs but as you find it seems to be generally better tolerated re gastro symptoms. Etoricoxib works a bit quicker than meloxicam too.

Can I ask how often is your omeprazole prescribed? I used to take 10mg once daily but following one of my annual med reviews a few years ago I now take it twice daily. Just thinking the extra dose would be further stomach protection for you too. Might be an idea to ask, if only for when you need etoricoxib, if that's considered a plan?

Hope this helps.

[weathervane in reply to nomoreheels]

i was initially on naproxen which I couldn’t tolerate, i was started on Etoricaxib which i have found easier to tolerate . I did have an increased episode of reflux and rheumatology changed omeprazole to lansoprazole which has been an improvement . I don’t have any experience of meloxicam .

[Merryroundabout in reply to weathervane]

Thank you, I didn’t know that changing PPIs could make a difference. It’s fascinating how different we are in our response to meds - I tolerated Naproxen but it didn’t help the pain.

[Merryroundabout in reply to nomoreheels]

Hi, that’s a sensible plan, thank you. Regarding the Omeprazole I request it as needed to take one 20mg every day that I take an NSAID. I’m protective of my tum nowadays - I took Nurofen for years and then the non-gastro-coated Diclofenac but neither were with a PPI. I’m on 20mg once a day, which on an Etoricoxib day I take on an empty stomach first thing in the morning, wait one hour then eat and drink, and then take the NSAID. My GP did tell me to take 20mg twice a day for two weeks recently because my stomach had been hurting after taking risedronate and needed to heal - thankfully I didn’t need to take any NSAIDS at that time.

[nomoreheels in reply to Merryroundabout]

It's for different needs, I have as many evening meds as morning so that's why I take omeprazole twice daily rather than the one dose. We differ in time to take etoricoxib. Because I was having trouble to get moving in the mornings it was suggested by my Consultant that I took it in the evening. It's just what works for us individually & why I sometimes hesitate to advise, not only is it not our place to, but it shows our needs can differ so rather better to share my experience & if it helps someone that's fine. I think how you take etoricoxib likely helps in having an quicker effect but I take it with my evening meal as I’m in bed asleep so restful when it starts to work.

I had to stop risedronate, & alendronate, so just take calcium/Vitamin D supplement & include dairy in my diet. Just switched up to full fat milk which I must say I’m particularly enjoying in my coffees! I hope your tum has recovered, not needed on top of stuff we've to deal with. 😊

[Moog73]

Morning merryroundabout🖐 I have had issues with etoricoxib tablets in the past.

I found it depends on the brand/manufacturer you use.

Try different brands of this drug to see if you have an improvement.

I also have a lot of sickly feelings and bad stomach from all the tablets we take, so I now have peptek regular also which has been a bit of a game changer with my stomach and bowls.

Hope you get this sorted. 👋

[Merryroundabout in reply to Moog73]

Thank you, I hadn’t considered the different brands but I’ll start taking notice of them now! I was sad to read how yucky the assortment of meds makes you feel, but so pleased a solution has been found 👍🏻

[oldtimer2]

I was on meloxicam for several years and controlled any occasional reflux problems with gaviscon. (The reflux didn't seem to be related to the meloxicam and was more related o my diet and anxiety levels on careful record keeping). But now I'm on adalumimab I don't need it any more - hurray! I also had nausea and occasional vomiting from the azathioprine, but I'm much better on a lower dose now I'm on the biologic.

[Merryroundabout in reply to oldtimer2]

I think the biologics work magic, if you qualify for them. My NSAID reaction is a burning, painful stomach rather than reflux - but I had months of reflux when I was pregnant and it’s horrible, I’m happy for you it’s not a problem any more.

[Barrister]

I take Arcoxia but only for a couple of days until the pain settles then I stop.

[Merryroundabout in reply to Barrister]

That’s what I’ve ended up doing, take for two or three days then one or two off and alternate days after that. Picking which is the first day with no meds is always a bit of a gamble though.

[Kags1068]

Hi there

I've had experience of the 2 drugs, but the other way around to you!

I was on 15mg Meloxicam and took it every day for about 20 years. My new rheumatologist wanted it changed to Etoricoxib 90mg daily, which I have. The only reason it was changed was because as I have also taken a drug called Cyclosporin for nearly 30 years, and it has caused some loss of kidney function. As NSAIDs can affect kidneys occasionally, the rheumatologist swapped to Etoricoxib as he felt that might be a bit kinder to them. I had no problems with Meloxicam apart from the tummy acid business which is to be expected after daily NSAIDs for so long. If I'm honest, I think the Meloxicam was probably a bit kinder on my tummy than the Etoricoxib.

As my acid issue worsened recently, I was told by an ENT consultant to split my Esomeprazole into 2 doses (20mg in morning, and 20mg 30minutes before evening meal). He also prescribed Peptac to be taken at bedtime. This regime has really helped. I was only swapped to Esomeprazole recently too. Prior to that I had been on 40mg Omeprazole for about 20 years with no problems.

The only other thing I would mention is that when my Rheumatologist did write to my GP to suggest the change from Meloxicam to Etoricoxib, my GP actually phoned me to see if it was really necessary as he felt it wouldn't make any difference to the kidneys to swap. My GP is lovely, but the cynic in me does suspect that Etoricoxib is a more expensive drug. I know that some people on here say their docs won't prescribe it, although I don't know whether cost is a factor.

As for how they work, I really can't say that one is superior to the other. I've found both to be equally ok.

Hope this helps 😊

[Merryroundabout in reply to Kags1068]

Hi, thank you so much for your reply, we’ve have visitors staying hence my delay in thanking you sooner. What you said is very helpful, I’m only on 20mg Omeprazole but I’m very careful to get best effect from it (I take it first thing in the morning on an empty stomach, wait for an hour then eat and drink, and then take the NSAID). I was on 90mg Etoricoxib but asked my original consultant if I could switch to try 60mg - I’d had a pharmacist refuse to issue the 90mg because it had a cardiac warning plus I’m asthmatic and all NSAIDs are contraindicated. He agreedThe 60mg is fine but takes longer to work. That’s great that you’ve been fine taking one or the other daily for such a long time, although needing changes to Omeprazole.

[Kags1068 in reply to Merryroundabout]

You are most welcome!😊 I can see why you asked to reduce to 60mg as you are asthmatic. Fortunately, I don't have that issue. 🤞I don't know which dose you've been prescribed, but you can usually take the Meloxicam at 7.5mg or 15mg daily so hopefully you will have a little wiggle room with that too. I always took 15mg and was fine.

Sounds like you are optimising the effects of the Omeprazole as much as possible, so that's good. Again if it were necessary (hopefully not) the dose could be changed or something like peptac added. Do bear in mind, the tummy meds have only been changed for me in the past year, so up until then I took 40mg Omeprazole daily for years with no change. Good luck with it, and I hope the Meloxicam suits you.

Hope you enjoyed your visitors' stay.

Best wishes 😊

[Merryroundabout in reply to Kags1068]

The Meloxicam dosage is useful to know - my tablets are only 7.5mg so yes, the extra wriggle room to increase the dose if I had a bad flare, say while away on holiday which has happened before unfortunately, would be enormously helpful. My GP has given me one pack to try and said if I get on with it I can switch, but I’m wary that it could be difficult to switch back later to the Etoricoxib. Splitting the Omeprazole dose is another strategy I could ask for, it’s so helpful to know how others have managed these meds, thank you. Guests have gone home now but it was lovely to see them. 😊

[Kags1068 in reply to Merryroundabout]

Glad it was helpful! It's always useful to have a bit of wiggle room with the medication. I always find it helpful to hear others' tips too! At least we can learn from each other. As I mentioned previously, the addition of peptac (or gaviscon) at bedtime really helped things too. I'd had peptac on and off for a few years and found it good, but sticking to a bedtime dose has helped the acid. It is tricky though when we are asked to try something different but worry about not being able to switch back if it's not as good. If I'm brutally honest, although I'm fine with the Etoricoxib, if I had the option I'd probably go back to Meloxicam as I feel it was easier on my tummy. We all differ though .......🤔

Glad you had a nice visit with your guests 😊