The potential effects of enzyme inducers or inhibitors of cytochrome P450 metabolism of meloxicam is unknown.
There are following interactions of meloxicam with other drugs:
ACE inhibitors: the nonsteroidal anti-inflammatories including meloxicam, can reduce the antihypertensive effect of inhibitors converting enzyme inhibitors, can cause uncontrolled hypertension
Aspirin administration of 1 g of aspirin twice daily to healthy volunteers AUC increased slightly (10%) and Cmax (24%) of meloxicam. The clinical significance of this interaction is unknown. However, concomitant administration of meloxicam and aspirin (or other nonsteroidal anti-inflammatory) is not recommended because the side effects may be additive.
Cholestyramine: administration of cholestyramine for 4 days before starting treatment with meloxicam increases clearance of the latter by 50% with a parallel reduction of the AUCs and elimination half-life. It has been suggested that this interaction could be useful in cases of overdose of meloxicam
Cimetidine despite cimetidine be a known inhibitor of CYP2C9 and CYP2D6 enzyme systems administration at a dose of 200 mg four times a day it did not affect the pharmacokinetics of a dose of 30 mg meloxicam.
Digoxin: Administration of meloxicam 15 mg / day did not affect plasma concentrations of digoxin. Nor it has found no interaction between meloxicam and digoxin as regards binding to plasma proteins.
Furosemide: the non-steroidal anti-inflammatories, including meloxicam, can reduce the natriuretic effect of furosemide and thiazide diuretics. This effect is due to the inhibiting effects of NSAIDs on renal prostaglandins. Although the studies conducted have not been observed interactions between furosemide and meloxicam, it is recommended to monitor renal function if meloxicam is administered concomitantly with diuretics.
Lithium: meloxicam administration induces an elevation of plasma lithium levels and reduced renal clearance. This effect is attributed to the effects of meloxicam on renal prostaglandins. It is recommended to monitor plasma levels of lithium if meloxicam is administered concomitantly.
Methotrexate has not been proven any interaction between methotrexate and meloxicam, while other NSAIDs reduce the clearance of the first with the corresponding risk of toxicity.
Warfarin: the concomitant administration of meloxicam and warfarin may increase the risk of bleeding in anticoagulated patients. Has occasionally checked INR increased in some subjects treated with warfarin and meloxicam, although in most cases have not been observed pharmacokinetic or pharmacodynamic interactions type. Caution is advised in patients anticoagulated because the meloxicam increases the risk of bleeding. INR monitoring is recommended when the new medication is introduced.
Other gastrolesive drugs: treatment with meloxicam in patients who consume alcohol or receive corticosteroids or other NSAIDs should be carefully monitored. An additive effect of the adverse effects on the digestive tract may occur. Although not specifically evaluated the interaction between meloxicam and alendronate, in a retrospective study, patients treated with both drugs showed an increase of 70% in the risk for gastric bleeding.
Meloxicam, like other anti-inflammatory drugs, possesses a certain antipyretic and analgesic activity can mask the symptoms of an infection, particularly in immunocompromised patients.
Some preclinical observations suggest that drugs that inhibit prostaglandin synthesis may reduce the effectiveness of photodynamic therapy with porfimer or verteporfin
Controlled trials have shown that the incidence of gastrointestinal side effects is lower than that observed with other NSAIDs such as piroxicam, diclofenac or naproxen. However, there have been reports of serious cases of gastrointestinal bleeding and perforation with meloxicam, and adverse reactions were gastrointestinal type who demonstrated more frequently. In a study of 12 months duration, the overall incidence of gastrointestinal adverse reactions was 17.3% at a dose of 7.5 mg / day and 20.1% with the dose of 15 mg. In this study, diclofenac (100 mg / day in a gradual release tablet) produced a 28.1%, while the placebo was 17.2%, that is only slightly less that meloxicam.
The most common gastrointestinal effects observed with doses of 7.5 and 15 mg / day of meloxicam were abdominal pain (1.9% vs. 2.6%), diarrhea (7.8% vs. 3.2%), dyspepsia (4.5% vs. 4.5%) , flatulence (3.2% vs. 3.2%) and nausea / vomiting (3.9% vs. 3.8%).
Other less common gastrointestinal effects (0.1-1.9%) are colitis, dry mouth, peptic ulcer, eructation, esophagitis, gastritis, gastroesophageal reflux, digestive tract bleeding, hematemesis, melena, pancreatitis, gastrointestinal perforations and ulcerative stomatitis.
Up to 15% of patients treated with meloxicam (and other NSAIDs) an elevation of transaminases or bilirubin may develop. These alterations of the representative parameters of liver function may be transient, disappearing with continued treatment or may remain or worsen. For meloxicam, hepatitis have been reported in
<2% of patients, while the incidence of jaundice and hepatic failure was
<0.1%. If clinical symptoms or systemic symptoms consistent with liver disease (eosinophilia, rash, etc.) are discovered should discontinue treatment with meloxicam.
It has been reported anemia (0-4-1%) and other rare hematological adverse reactions during treatment with meloxicam (leukopenia, purpura, thrombocytopenia). Very rarely (<0.1%) has occurred agranulocytosis. A watch on hematological parameters, particularly hemoglobin and hematocrit if symptoms of anemia or bleeding were complied recommended.
Or respiratory allergic reactions are rare (0.1-1.9%) and include angioedema, asthma, bronchospasm, dyspnea and fever. Very rarely (<0.1) anaphylactic reactions have been reported. Patients with hypersensitivity to aspirin are at an increased risk for these reactions. Patients who develop urticaria, bronchospasm and other symptoms of an anaphylactic reaction should be taken immediately to an emergency department.
Other relatively common (but similar to placebo) adverse effects are dizziness (2.6-3.8% vs. placebo 3.2%), influenza-like symptoms (4.5-5.8% vs. placebo 5.1%), pharyngitis (0.6-3.2% vs. placebo 1.3%) and upper respiratory tract infections (1.9-3.2% vs. placebo 1.9%).
In 2.6% of patients treated with 7.5 mg of meloxicam a nonspecific rash occurred in 0.6% of patients treated with 15 mg / day and 2.5% of those treated with placebo. Other dermatological reactions observed (regardless of causality) were alopecia, bullous rash, pruritus, photosensitivity, increased sweating, and hives. Are few cases in which meloxicam has been associated with erythema multiforme, a toxic epidermal necrolysis or a Stevens-Johnson syndrome.
Edema (in its broadest definition) has been observed in 1.9-4.5% of patients treated with meloxicam. Other rare side effects (0.1-1.9%) related to fluid retention are weight gain, heart failure and hypertension. They also are rare adverse reactions such as renal albuminuria, azotemia, increased serum creatinine, hematuria and renal failure. Interstitial nephritis occurs in
<0.1% of cases.