Simultaneous administration of meloxicam with the following drugs mandates careful supervision and monitoring of the clinical and laboratory status of the patient.
The following combinations are inadvisable: Other NSAIDs, High Dosages of Salicylates: The risk of gastrointestinal ulceration and/or gastrointestinal bleeding is increased when administering several NSAIDs together due to synergistic effects.
Lithium: Blood lithium levels are increased by NSAIDs due to decreased renal excretion of lithium. Consequently, lithium levels may reach toxic levels, therefore, blood lithium levels should be monitored during initiation, dose titration and withdrawal of meloxicam.
Oral Anticoagulants, Ticlopidine, Parenteral Heparin: Due to inhibition of platelet function and gastroduodenal mucosa damage, there is an increased risk of bleeding. In the event that use of such combinations is unavoidable, the effect of the anticoagulants must be closely monitored.
High Dosage Methotrexate (≥15 mg/week): NSAIDs decrease the renal clearance of methotrexate resulting in increased haematological toxicity of methotrexate. Although causality has not been confirmed, there is a report of agranulocytosis in a patient treated with methotrexate and meloxicam. Prescription of such combination requires caution and close monitoring of the blood cell count is recommended in such an instance (see also text as follows).
Simultaneous administration of meloxicam with the following drugs requires precautions: Cyclosporin: NSAIDs may enhance the nephrotoxicity of cyclosporin due to renal prostaglandin-mediated effects. Renal function must be measured during combination therapy.
Diuretics: NSAIDs therapy results in decreased renal prostaglandin synthesis with consequent decreased glomerular filtration resulting in an elevated risk of acute renal failure in dehydrated patients. Use of meloxicam with a diuretic means it is essential to ensure the patient is adequately hydrated and to closely monitor renal function at the initiation of such therapy.
Low Dosage Methotrexate (<15 mg/week): NSAIDs decrease the renal clearance of methotrexate resulting in increased haematological toxicity of methotrexate. Blood count should be monitored weekly during the 1st few weeks of such combination therapy. In elderly patients, and those with even slight renal impairment, require increased monitoring and close supervision.
Pentoxifylline: There is an increased risk of bleeding, and general clinical monitoring and verification of bleeding time should be of increased frequency.
Zidovudine: Due to effects on the reticulocytes, there is an increased risk of greater red cell line toxicity effects, with severe anaemia resulting 1 week after NSAID therapy is initiated. The CBC and reticulocyte count should be checked 1 or 2 weeks post-NSAID therapy initiation.
Simultaneous administration of meloxicam with the following drugs requires caution and appropriate precautions should be taken: Antihypertensives (β-blockers, angiotensin-converting enzyme inhibitors, diuretics): NSAID therapy inhibits prostaglandin synthesis and may result in a decrease of the antihypertensive effect.
Intrauterine Devices (IUD): There is a possible risk of impaired efficacy, and additional contraceptive precautions may be required.
Thrombolytics: There is an elevated risk of bleeding.
Others: Antacids, H2-Receptor Agonists (Cimetidine, Ranitidine), Furosemide, β-Acetyl Digoxin: Concomitant administration with meloxicam has not resulted in any significant pharmacokinetic interactions.
Cholestyramine: The elimination of meloxicam is accelerated due to binding in the digestive tract.
Oral Antidiabetics: The possibility of interactions cannot be excluded; such patients should be closely monitored and supervised.