Most people have taken medication for pain relief at some point in their lives. Common over-the-counter pain relievers work well to control acute pain from minor ailments or injuries. People who are living with chronic (long-lasting) conditions like arthritis and other autoimmune diseases often need chronic pain management. While there are different treatment modalities and medications used for chronic pain, today, we will focus on diclofenac and meloxicam - two commonly prescribed NSAIDs (nonsteroidal anti-inflammatory drugs) and see how they compare to each other in treating pain.

What are nonsteroidal anti-inflammatory drugs?

Nonsteroidal anti-inflammatory drugs (NSAIDs, pronounced in-seds) are a group of medications commonly used to treat menstrual cramps, mild to moderate aches, and pain from minor injuries. NSAIDs are also known for their role in alleviating joint inflammation and pain due to osteoarthritis (OA), rheumatoid arthritis (RA), juvenile rheumatoid arthritis, and ankylosing spondylitis. 

Next to Tylenol (acetaminophen), NSAIDs are a common household name known for their effectiveness in treating cold and flu symptoms and as a fever reducer. These drugs are available in oral liquid form, making them good options for children and adults with trouble swallowing. 

Examples of nonsteroidal anti-inflammatory drugs include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), nabumetone (Relafen), celecoxib (Celebrex), diclofenac (Voltaren, Cataflam, Zorvolex), and meloxicam (Mobic, Vivlodex). 

Some NSAIDs are available as over-the-counter products and also as prescription medications; ibuprofen, naproxen, and aspirin are some examples. The main difference between an OTC product and its prescription counterpart is the active ingredient and amount of drug in each unit (i.e., tablet, capsule). In other words, prescription medication contains more of the same drug compared to the OTC drug. For example, ibuprofen (Advil) 100 mg and 200 mg are available over the counter. However, higher strength of ibuprofen, 400 mg, 600 mg, and 800 mg, will require a prescription.

Can NSAIDs cause stomach ulcers?

Taking a nonsteroidal anti-inflammatory drug (NSAID) can effectively relieve pain and treat arthritis. However, these drugs can increase your risk of stomach ulcers and stomach bleeding. Besides the concern for gastrointestinal side effects, NSAIDs also have precautions for cardiovascular events such as heart attacks. These risks are even higher for elderly patients and those with existing liver disease and kidney problems.

If you are taking other medications, you should inform your doctor of all medications you are taking to avoid possible drug interactions. For example, NSAIDs can interact with blood pressure medications making them less effective.  Angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs) are examples of blood pressure medications that can become less effective if taking an NSAID concurrently. 

In addition, just like any other drugs, some people can develop an anaphylactic reaction to NSAIDs; this is a severe allergic reaction presenting with a skin rash, nausea, vomiting, or swelling of the tongue or throat, causing difficulty breathing. This is a medical emergency and requires immediate medical care, as it is life-threatening if left untreated.

Is diclofenac a strong painkiller? 

Diclofenac is used to treat mild to moderate pain. It is prescribed for joint pain, inflammation, swelling, and stiffness caused by arthritis. Oral diclofenac is a prescription drug. However, topical diclofenac gel (Voltaren Arthritis Pain) is available over the counter to treat arthritis pain in various joints.

Voltaren topical gel used to be a prescription medication. In 2020, the FDA switched Voltaren’s status from a prescription-only drug to an OTC product. The OTC version of Voltaren topical gel contains 1% of diclofenac, which is the same active ingredient and strength that previously required a prescription. 

Is meloxicam a strong painkiller?

Meloxicam is a strong painkiller. It is a prescription medication and is used to treat tenderness, pain, swelling, and stiffness caused by osteoarthritis and rheumatoid arthritis.

Diclofenac versus Meloxicam: A Comparison

Similarities

• Both are nonsteroidal anti-inflammatory drugs that can effectively treat pain and inflammation.
• Low-cost generics are available for both diclofenac and meloxicam.
• Neither diclofenac nor meloxicam is a controlled substance.
• Both medications can increase the risk of bleeding due to their antiplatelet effects. This bleeding risk is even higher if you are currently taking a blood thinner like warfarin, rivaroxaban (Xarelto), and apixaban (Eliquis); or if you are using an antiplatelet medicine like clopidogrel (Plavix).   
• Like other NSAIDs, diclofenac and meloxicam have cardiovascular and gastrointestinal boxed warnings. More specifically, diclofenac and meloxicam can increase the risk of heart attacks and strokes for someone with or without existing heart disease. As far as gastrointestinal side effects, both drugs are associated with an increased risk of stomach bleeding and stomach ulcers. The risk of stomach bleeding and ulceration increases with higher doses.
• Diclofenac and meloxicam can have drug interactions with blood thinners and blood pressure medications. Taking an NSAID with a blood thinner can increase your bleeding risks. On the other hand, when taken together, NSAIDs can make certain blood pressure medications less effective, leading to uncontrolled high blood pressure. It is not safe to take certain medications like blood thinners with NSAIDs. You should check with your doctor before taking a high blood pressure medication and NSAID together. You should discuss other alternatives for pain treatment if you are taking a blood pressure medication or a blood thinner. 

Differences

• Brand names for meloxicam are Mobic and Anjeso (a long-acting injection of meloxicam). Diclofenac brand names are Voltaren, Cataflam, Cambia, and Zorvolex.
• Generic meloxicam costs approximately $6.50 for 30 of the 7.5 mg tablets. Diclofenac costs approximately $12 for 30 of the 75 mg tablets. Higher doses of both drugs may cost more.
• Dosage forms for meloxicam include oral tablet, oral disintegrating tablet, capsule, and oral suspension, and intravenous solution. 
• Dosage forms for diclofenac include oral tablets (enteric coated, and extended-release), ophthalmic solution, topical gel, and topical solution..
• The half-life of meloxicam is 20 hours, whereas that of diclofenac is 2 hours. Half-life is the time it takes for the quantity of the drug to reduce to half of its original amount. This means meloxicam stays in the body far longer and can be dosed once a day. In contrast, diclofenac stays in the body for a shorter time and needs to be dosed multiple times a day.

Frequently Asked Questions About Diclofenac and Meloxicam 

What is stronger ibuprofen 800 or meloxicam 15 mg?

In general, meloxicam is considered a stronger painkiller and requires a prescription from a healthcare provider. On the other hand, ibuprofen is available both over-the-counter (OTC) and by prescription for higher-strength products. 

Specifically, meloxicam tablets may be stronger than OTC ibuprofen. However, meloxicam and prescription-strength ibuprofen may be equally effective. 

The usual dosage of meloxicam is 7.5 mg to 15 mg once a day in adults. The typical dosage of ibuprofen is 200 to 400 mg every 4 to 6 hours as needed. The maximum daily dose of OTC ibuprofen in adults is 1200 mg; the maximum daily dose of prescription ibuprofen is 3200 mg. Ibuprofen is intended to be used as needed for pain relief, while meloxicam should be taken once daily. Do not take a double dose to make up for a missed dose. If you miss a dose, take the next dose as soon as you remember without doubling the dose for the missed dose.

How long does it take for meloxicam to start working for pain?

Some people notice an improvement in symptoms like pain, tenderness, swelling, and stiffness within 24 to 72 hours of taking meloxicam. However, in many people, it can take up to two weeks to get benefits from this medicine. In some individuals, it may take several months for meloxicam to reduce pain and provide significant improvement in osteoarthritis and rheumatoid arthritis symptoms.

What kind of pain does meloxicam help?

Meloxicam is a prescription NSAID that helps with pain and inflammation caused by osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis. Meloxicam works by blocking cyclo-oxygenase (COX) enzymes, which are natural body chemicals needed to make prostaglandins. Prostaglandins are part of the body’s inflammatory response when dealing with an injury or illness. This hormone-like substance is responsible for pain, inflammation, and fever as part of the normal healing process. By blocking the COX enzymes, meloxicam interferes with prostaglandin production. As a result, pain and inflammation are reduced. 

How does meloxicam make you feel? 

Taking meloxicam can cause side effects like nausea, dizziness, and upset stomach. You should tell your doctor if these side effects are severe or do not go away after a few days. Drinking alcohol can make adverse effects like dizziness worse.

Contact your doctor immediately and seek immediate medical attention for warning symptoms of serious side effects, such as unusual tiredness, severe stomach pain, black tarry stools, coffee grounds vomit, skin rash (allergic reaction), trouble breathing, or swelling. 

Should diclofenac be taken on an empty stomach? 

You can take diclofenac tablets with or without food. However, you should take diclofenac capsules on an empty stomach.

Can you drink coffee while taking diclofenac? 

Diclofenac and other NSAIDs can irritate the lining of the stomach. It is best to avoid alcohol while taking an NSAID.

What is the best nonsteroidal anti-inflammatory drug to treat pain?

Most over-the-counter NSAIDs are intended to treat general aches and pain such as primary dysmenorrhea (menstrual cramps), back pain, and toothache. Advil (ibuprofen) and Aleve (naproxen) are two commonly used NSAIDs for mild to moderate pain that does not require immediate medical attention.

Prescription NSAIDs typically have more specific indications. For example, meloxicam is only approved to treat arthritic-related pain and inflammation. Your healthcare provider will work with you to achieve the most appropriate treatment regimen based on your medical history, risk factors, and your concurrent medications.

The goal is to pick an NSAID that is effective in treating your pain and inflammation with the least side effects possible; this process may require some periods of trial and error. The good news is that there are several varieties of NSAIDs to choose from. Also, keep in mind that, overall, there is no “best” NSAID since different people react differently to the same medication. Therefore, the best NSAID would be the one that you can tolerate while getting the most symptom relief for your condition.

References:

1. https://orthoinfo.aaos.org/en/treatment/what-are-nsaids/
2. https://americanmigrainefoundation.org/resource-library/nsaids-migraine/#:~:text=The%20best%2Dknown%20NSAIDs%20used,%2Dprescription)%20and%20by%20prescription
3. https://www.uspharmacist.com/article/nsaids-balancing-the-risks-and-benefits

https://pubmed.ncbi.nlm.nih.gov/8630630/