Movi-Cox Drug Interactions

Other Prostaglandin Synthetase Inhibitors (PSI) Including Glucocorticoids and Salicylates (Acetylsalicylic Acid): Co-administration of PSIs may increase the risk of GI ulcers and bleeding, via a synergistic effect and is not recommended. The concomitant use of meloxicam with other NSAIDs is not recommended.
Concomitant administration of aspirin (1000 mg 3 times daily) to healthy volunteers tended to increase the AUC (10%) and C_max (24%) of meloxicam. The clinical significance of this interaction is not known.
Oral Anticoagulants, Antiplatelet Drugs, Systemically Administered Heparin, Thrombolytics and Selective Serotonin Re-Uptake Inhibitors (SSRIs): Increased risk of bleeding, via inhibition of platelet function.
Lithium: NSAIDs have been reported to increase lithium plasma levels (via decreased renal excretion of lithium), which may reach toxic values. The concomitant use of lithium and NSAIDs is not recommended. If this combination appears necessary, lithium plasma concentrations should be monitored carefully during the initiation, adjustment and withdrawal of meloxicam treatment.
Methotrexate: NSAIDs can reduce the tubular secretion of methotrexate thereby increasing the plasma concentrations of methotrexate. For this reason, for patients on high dosages of methotrexate (>15 mg/week) the concomitant use of NSAIDs is not recommended. The risk of an interaction between NSAID preparations and methotrexate, should be considered also in patients on low dosage of methotrexate, especially in patients with impaired renal function. In case combination treatment is necessary blood cell count and the renal function should be monitored. Caution should be taken in case both NSAID and methotrexate are given within 3 days, in which case the plasma level of methotrexate may increase and cause increased toxicity. Although the pharmacokinetics of methotrexate (15 mg/week) were not relevantly affected by concomitant meloxicam treatment, it should be considered that the haematological toxicity of methotrexate can be amplified by treatment with NSAID drugs.
Contraception: A decrease of the efficacy of intrauterine devices by NSAIDs has been previously reported but needs further confirmation.
Diuretics: Treatment with NSAIDs is associated with the potential for acute renal insufficiency in patients who are dehydrated. Patients receiving Movi-Cox and diuretics should be adequately hydrated and be monitored for renal function prior to initiating treatment.
Antihypertensives (eg, β-Blockers, ACE Inhibitors, Vasodilators, Diuretics): A reduced effect of the antihypertensive drug by inhibition of vasodilating prostaglandins has been reported during treatment with NSAIDs.
NSAIDs and angiotensin-II receptor antagonists as well as ACE inhibitors exert a synergistic effect on the decrease of glomerular filtration. In patients with preexisting renal impairment this may lead to acute renal failure.
Cholestyramine binds meloxicam in the GI tract leading to a faster elimination of meloxicam. Nephrotoxicity of cyclosporine may be enhanced by NSAIDs via renal prostaglandin-mediated effects. During combined treatment renal function is to be measured.
Meloxicam is eliminated almost entirely by hepatic metabolism, of which approximately ²/₃ are mediated by cytochrome (CYP) P-450 enzymes (CYP2C9 major pathway and CYP3A4 minor pathway) and ¹/₃ by other pathways eg, peroxidase oxidation. The potential for a pharmacokinetic interaction should be taken into account when meloxicam and drugs known to inhibit, or to be metabolized by, CYP2C9 and/or CYP3A4 are administered concurrently.
No relevant pharmacokinetic drug-drug interactions were detected with respect to the concomitant administration of antacids, cimetidine, digoxin and furosemide.
Interactions with oral antidiabetics cannot be excluded.