Avegesic Drug Interactions

Inadvisable combinations: Other NSAIDs, including high doses of salicylates: administration of several NSAIDs together may increase the risk of ulcers and of gastrointestinal bleeding, via a synergistic effect.
Corticosteroids: increased risk of gastrointestinal ulceration or bleeding.
Anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs): increased risk of gastrointestinal bleeding.
Anti-coagulants: NSAIDs may enhance the effects of anticoagulants, such as warfarin.
Oral anticoagulants, heparin and ticlopidine: increased risk of bleeding via inhibition of platelet function and damage to the gastroduodenal mucosa. Careful monitoring of the effects of anticoagulants is thus essential if it proves impossible to avoid such combined prescription.
Lithium: NSAIDs increase blood lithium levels, which may then reach toxic values ( decreased renal excretion of lithium). This parameter therefore requires monitoring during the initiation, adjustment and withdrawal of treatment with meloxicam.
Methotrexate: NSAIDs may accentuate the haematologic toxicity of methotrexate. A case of agranulocytosis with meloxicam has been reported in a patient who was also taking methotrexate. The direct causality of meloxicam was not confirmed, but caution is required before prescribing such a combination. Strict monitoring of blood cell count is recommended in this situation.
Intrauterine contraceptive devices: NSAIDs appear to decrease the efficacy of intrauterine contraceptive devices.
Combinations requiring precautions: Diuretics: treatment with NSAIDs is associated with a risk of acute renal failure in dehydrated patients (decreased glomerular filtration via decreased renal prostaglandin synthesis). In case of combined prescription of meloxicam and a diuretic, it is essential to ensure that the patient is adequately hydrated and to monitor renal function at the start of treatment.
Nephrotoxicity of cyclosporin may be enhanced by NSAIDs via renal prostaglandin mediated effects. During combined treatment renal function is to be measured.
Associations needing to be taken into consideration: antihypertensive drugs [beta- blockers, angiotensin converting enzyme (ACE) inhibitors, diuretics]: treatment with a NSAID may decrease their antihypertensive effect via inhibition of vasodilator prostaglandin synthesis.
Thrombolytics: increased risk of haemorrhage. Concomitant administration of antacids, cimetidine, β- acetyl digoxin and frusemide has not given rise to any notable pharmacokinetic interactions with meloxicam.
Cholestyramine accelerates the elimination of meloxicam via binding in the digestive tract. Interactions with oral anti- diabetics cannot be excluded.