NSAID Classification and Safety

Introduction to NSAID Classes

• The American Academy of Allergy, Asthma, and Immunology recommends classifying NSAIDs based on their chemical structure, which impacts their pharmacological properties and side effect profiles, with meloxicam belonging to the enolic acids/oxicam class and diclofenac belonging to the acetic acids class 1

Cardiovascular Risk

• The American Heart Association notes that both oxicams (meloxicam) and acetic acids (diclofenac) have been associated with increased cardiovascular risk, with diclofenac having a higher risk of thrombotic events compared to some other NSAIDs 2

Gastrointestinal Tolerability and Bleeding Risk

• The American College of Gastroenterology acknowledges that both drugs are associated with increased risk of bleeding, and a meta-analysis found that diclofenac and meloxicam use was associated with an increased risk of hemorrhagic stroke 3

Hypersensitivity Reactions and Severe Cutaneous Adverse Reactions

• The American Academy of Allergy, Asthma, and Immunology recommends that patients who experience hypersensitivity reactions to one NSAID may cross-react with others in the same chemical class, and both oxicams (meloxicam) and acetic acids (diclofenac) have been associated with severe cutaneous adverse reactions, with potentially higher risk than other NSAID classes 1

Patient Considerations

• When choosing between meloxicam and diclofenac, consider the patient's cardiovascular risk, as both drugs carry cardiovascular risks, but diclofenac has been specifically identified as having higher thrombotic risk, and prior hypersensitivity reactions, as patients who have had a reaction to one class may safely use an NSAID from a different chemical class 1, 2