Diclofenac vs. meloxicam: Differences, similarities, and cost comparison

In this article:

• What are the main differences between diclofenac and meloxicam?
• Conditions treated by diclofenac and meloxicam
• Is diclofenac or meloxicam more effective?
• Coverage and cost comparison of diclofenac vs meloxicam
• Common side effects of diclofenac vs meloxicam
• Drug interactions of diclofenac vs meloxicam
• Warnings of diclofenac and meloxicam

In this article

• What are the main differences between diclofenac and meloxicam?
• Conditions treated by diclofenac and meloxicam
• Is diclofenac or meloxicam more effective?
• Coverage and cost comparison of diclofenac vs meloxicam
• Common side effects of diclofenac vs meloxicam
• Drug interactions of diclofenac vs meloxicam
• Warnings of diclofenac and meloxicam

If you experience pain from arthritis, you may be recommended a nonsteroidal anti-inflammatory drug (NSAID) like diclofenac or meloxicam. These medications are widely used for treating pain and inflammation. Both diclofenac and meloxicam are generic prescription drugs used for similar purposes and are often accessible with or without insurance coverage.

Although diclofenac and meloxicam are used for similar purposes, they differ in various ways, including available dosage forms, age restrictions, and potential side effects. They may also differ in how they work and block cyclooxygenase (COX) enzymes. Therefore, it’s always recommended to consult a healthcare provider for the most appropriate treatment. 

Continue reading to learn more about the similarities and differences between diclofenac and meloxicam. 

What are the main differences between diclofenac and meloxicam?

Diclofenac and meloxicam are both NSAIDs used for pain relief and inflammation. They treat conditions such as arthritis but vary in several aspects.

Mechanism of action

COX enzymes, specifically COX-1 and COX-2, are responsible for producing prostaglandins. While both COX enzymes produce prostaglandins that promote inflammation, COX-1 also produces prostaglandins that protect the stomach lining from stomach acid. Therefore, non-selective NSAIDs that block both COX enzymes may have a higher risk of causing stomach ulcers compared to partially selective NSAIDs.

Diclofenac blocks both COX-1 and COX-2 enzymes, which may help reduce pain and inflammation but may increase the risk of gastrointestinal issues. Meloxicam primarily blocks COX-2, making it potentially gentler on the stomach while providing anti-inflammatory benefits.

Dosing and dosage forms

Diclofenac comes in various forms, including tablets, capsules, topical gels, and injections. It is also available under different brand names, including Voltaren, Cambia, and Zorvolex. The oral tablets are typically taken two to four times per day, depending on the condition being treated, while the topical gel is generally applied four times daily. Unlike meloxicam, diclofenac topical gel is available over the counter under the brand name Voltaren Gel. 

Meloxicam is typically available in tablets, capsules, oral suspensions, and injections. The typical dosage is 7.5 mg once daily. However, the dosage may be increased to 15 mg once daily. Unlike diclofenac, meloxicam is only available with a prescription from a healthcare provider. The brand names of meloxicam include Mobic and Vivlodex. However, the brand-name versions may no longer be on the market. 

Main differences between diclofenac and meloxicam
	Diclofenac	Meloxicam
Drug class	Nonsteroidal anti-inflammatory drug (NSAID)	Nonsteroidal anti-inflammatory drug (NSAID)
Brand/generic status	Brand and generic available	Brand and generic versions available
What is the brand name?	Voltaren Cambia Cataflam Zipsor Zorvolex	Mobic Vivlodex
What form(s) does the drug come in?	Oral tablet Oral capsule Oral suspension Solution for injection Topical gel  Topical solution Rectal suppository	Oral tablet Oral capsule Oral suspension Solution for injection
What is the standard dosage?	The dosage depends on the type of pain being treated and the dosage form used. For example, the typical oral dosage for osteoarthritis is 50 mg two to three times per day, while the topical dosage is 2 or 4 g of gel to the affected area four times daily.	The dosage depends on the type of pain being treated and the dosage form used. The typical oral dosage is 7.5 to 15 mg daily.
How long is the typical treatment?	Short-term or long-term, as instructed by a healthcare provider	Short-term or long-term, as instructed by a healthcare provider
Who typically uses the medication?	Adults	Adults and children aged two years and older

Conditions treated by diclofenac and meloxicam

Diclofenac and meloxicam are NSAIDs approved by the U.S. Food and Drug Administration (FDA) to treat osteoarthritis and rheumatoid arthritis. These conditions are often accompanied by joint pain and inflammation. Diclofenac and meloxicam may be potential options for short-term or long-term use with guidance from a healthcare provider. 

In addition to osteoarthritis and rheumatoid arthritis, diclofenac is approved to treat chronic and acute pain from ankylosing spondylitis, a type of arthritis that affects the spine. Meloxicam is sometimes used off-label for this purpose. 

Meloxicam is also approved for juvenile rheumatoid arthritis, a chronic inflammatory condition that affects children under the age of 16. It may be prescribed for children and adolescents with juvenile rheumatoid arthritis who weigh at least 132 lbs or 60 kg. 

Diclofenac and meloxicam may sometimes be used for general mild or moderate acute pain, such as pain following surgery or injury, dental pain, menstrual cramps, and headaches.

Condition	Diclofenac	Meloxicam
Osteoarthritis	Yes	Yes
Rheumatoid arthritis	Yes	Yes
Ankylosing spondylitis	Yes	Off-label
Juvenile rheumatoid arthritis	Off-label	Yes

Is diclofenac or meloxicam more effective?

Multiple clinical trials have shown that diclofenac and meloxicam may be more effective than placebo for pain and inflammation.

One study compared diclofenac and meloxicam for treating osteoarthritis of the lumbar spine. Results found no statistically significant differences in pain relief between diclofenac and meloxicam. Both drugs provided substantial improvements in pain and inflammation for patients. However, meloxicam was better tolerated, with 7% more patients reporting fewer side effects than diclofenac.

The MELISSA trial was a double-blind comparison of the safety of meloxicam and diclofenac. It found that meloxicam caused fewer gastrointestinal issues, with 13% of patients experiencing problems compared to 19% for diclofenac. Additionally, fewer patients stopped taking meloxicam due to side effects (5.48%) compared to diclofenac (7.96%).

A doctor or healthcare provider should determine the most effective treatment. This decision depends on a person’s medical history, current medications, and response to treatment. 

Coverage and cost comparison of diclofenac vs meloxicam

Diclofenac and meloxicam are generic medications typically covered by more insurance plans, including Medicare Part D and Medicare Advantage plans. However, the level of coverage can vary based on the specific insurance plan, the form of the medication, and the quantity prescribed. Diclofenac topical gel is available over the counter and may come with higher out-of-pocket costs than covered diclofenac forms. 

The average retail prices of these medications can vary. A SingleCare discount card can be used to save on the cost of diclofenac and meloxicam at participating pharmacies. 

	Diclofenac	Meloxicam
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Quantity	50 mg (14 tablets)	7.5 mg (30 tablets)
Typical Medicare copay	Varies	Varies
SingleCare cost	$2	$5

Common side effects of diclofenac vs meloxicam

As NSAIDs, diclofenac and meloxicam share many of the same side effects. Both medications often cause gastrointestinal side effects, such as nausea, diarrhea, and abdominal pain. 

Both medications share some common side effects, but meloxicam often has an improved safety profile and better tolerability parameters. It may lead to fewer severe adverse events compared to diclofenac.

Some people may experience serious side effects, including liver problems, kidney problems, and severe allergic reactions that require immediate medical attention. Heart attacks and duodenal ulcers are also risks associated with long-term use. 

	Diclofenac		Meloxicam
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Diarrhea	Yes	1%-10%	Yes	8%
Indigestion	Yes	1%-10%	Yes	5%
Gas	Yes	1%-10%	Yes	3%
Constipation	Yes	1%-10%		1%
Abdominal pain	Yes	1%-10%	Yes	2%
Headache	Yes	1%-10%	Yes	8%
Nausea	Yes	1%-10%	Yes	4%
Vomiting	Yes	1%-10%	Yes	1%
Swelling in the hands, legs, and feet	Yes	1%-10%	Yes	2%
Drowsiness	Yes	1%-10%	No	–
Insomnia	Yes	1%-10%	Yes	0.4%
Dizziness	Yes	1%-10%	Yes	3%
Flu-like symptoms	No	–	Yes	5%
Sore throat	No	–	Yes	1%
Rash	Yes	1%-10%	Yes	3%

Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.

Source: DailyMed (Diclofenac), DailyMed (Meloxicam)

Drug interactions of diclofenac vs meloxicam

Diclofenac and meloxicam interact with several other medications, which can increase the risk of severe side effects. Both diclofenac and meloxicam may cause an increased risk of gastrointestinal bleeding, especially when combined with blood thinners, such as aspirin, warfarin, and certain antidepressants.

Combining diclofenac or meloxicam with blood pressure medications such as ACE inhibitors, angiotensin receptor blockers (ARBs), or beta-blockers can reduce the effectiveness of these blood pressure drugs. This means your blood pressure might not be as well controlled as it should be. Monitoring your blood pressure regularly is important if you take any of these combinations.

For older adults, those who are dehydrated, or those with kidney problems, using diclofenac or meloxicam with ACE inhibitors or ARBs may worsen kidney function. If you fall into one of these high-risk groups, your doctor will need to keep a close eye on your kidney health.

In addition, using diclofenac or meloxicam with diuretics can reduce the effectiveness of the diuretics. These drugs are often used to help control blood pressure and reduce swelling by helping your body get rid of extra salt and water. If you are taking these medications together, you’ll need to be monitored to make sure the diuretics are still working properly.

Drug	Drug Class	Diclofenac	Meloxicam
Aspirin	Antiplatelet	Yes	Yes
Coumadin (warfarin)	Anticoagulant	Yes	Yes
Paxil (paroxetine) Zoloft (sertraline) Lexapro (escitalopram) Prozac (fluoxetine)	Selective serotonin reuptake inhibitor (SSRI) antidepressant	Yes	Yes
Effexor (venlafaxine) Pristiq (desvenlafaxine)	Serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant	Yes	Yes
Vasotec (enalapril) Prinivil (lisinopril) Lotensin (benazepril)	Angiotensin-converting enzyme (ACE) inhibitors	Yes	Yes
Cozaar (losartan) Diovan (valsartan) Avapro (irbesartan) Atacand (candesartan)	Angiotensin receptor blockers (ARBs)	Yes	Yes
Lopressor (metoprolol) Coreg (carvedilol) Tenormin (atenolol)	Beta-blockers	Yes	Yes
Microzide (hydrochlorothiazide) Lasix (furosemide)	Diuretics	Yes	Yes
Lithobid (lithium)	Mood stabilizer	Yes	Yes
Trexall (methotrexate)	Antimetabolite	Yes	Yes
Lanoxin (digoxin)	Cardiac glycoside	Yes	Yes

This may not be a complete list of all possible drug interactions. Consult a doctor about all medications you may be taking.

Warnings of diclofenac and meloxicam

Diclofenac and meloxicam may carry several warnings that should be kept in mind before starting treatment. Below are some important precautions to consider:

• Cardiovascular risks: Diclofenac and meloxicam, like other NSAIDs, can increase the risk of serious cardiovascular events like heart attack and stroke. These risks may be higher with prolonged use and in people with existing heart disease.
• Gastrointestinal issues: Both medications can cause gastrointestinal problems such as bleeding, ulcers, and perforations. These can occur without warning and may be fatal.
• Kidney and liver concerns: Diclofenac and meloxicam can lead to kidney and liver damage, especially when used over long periods or in high doses. It’s important for people taking these drugs to have regular check-ups to monitor their kidney and liver function.
• Pregnancy: Pregnant women should avoid using these drugs, especially after 30 weeks gestation. These drugs can cause problems for the baby, such as closing an important blood vessel in the baby’s heart too early (premature closure of the ductus arteriosus). 
• Allergic reactions: Both drugs can cause severe allergic reactions, including anaphylaxis. Symptoms can include rash, swelling, and difficulty breathing. If these symptoms occur, immediate medical attention is necessary.

Unlike opioids, which are stronger pain relievers, neither diclofenac or meloxicam is classified under the Controlled Substances Act. They do not have a potential for dependence or withdrawal symptoms.

This article provides information about the potential benefits and risks associated with these medications. Patients should discuss these potential benefits and risks with a healthcare provider to determine the best course of action.