Dosing & Uses
Dosage Forms & Strengths
Bupivacaine/meloxicam
extended-release solution for soft-tissue or periarticular instillation
- 60mg/1.8mg as 2.3-mL single-dose vial
- 200mg/6mg as 7-mL single-dose vial
- 300mg/9mg as 10.5-mL single-dose vial
- 400mg/12mg as 14-mL single-dose vial
- Concentration: (29.25mg/0.88mg)/mL
- Kit contains: 5 vented vial spikes, 10 Luer lock applicators, 10 sterile 3-mL Luer lock syringes, 8 sterile 12-mL Luer lock syringes
Postoperative Analgesia
Indicated in adults for soft tissue or periarticular instillation to produce postsurgical analgesia for up to 72 hr after foot and ankle, small-to-medium open abdominal, and lower extremity total joint arthroplasty surgical procedures
Foot and ankle surgical procedures (eg, bunionectomy)
- Up to 2.3 mL (bupivacaine 60 mg/meloxicam 1.8 mg); apply to proximal and distal ends (ie, beyond the boney repair) of the wound
Small-to-medium open abdominal procedures (open inguinal herniorrhaphy)
- Up to 10.5 mL (bupivacaine 300 mg/meloxicam 9 mg); apply above and below the fascial repair
Lower extremity total joint arthroplasty surgical procedures (eg, total knee arthroplasty)
- Up to 14 mL (bupivacaine 400 mg/meloxicam 12 mg); apply directly to posterior capsule, the anteromedial tissues and periosteum, and the anterolateral tissues and periosteum after cementation of the components
Dosage Modifications
Renal impairment
- Mild-to-moderate: Consider reducing dose
- Severe: Not studied and not recommended
- Hemodialysis: Meloxicam is not dialyzable; do not exceed maximum recommended meloxicam dose or use with other meloxicam-containing products
Hepatic impairment
- Mild-to-moderate: No dosage adjustment required
- Severe: Only use if benefits outweigh the risks; monitor for signs of worsening liver function
Poor CYP2C9 metabolizers
- Consider dose reduction in patients who are known or suspected poor CYP2C9 metabolizers
Dosing Considerations
Avoid additional use of other local anesthetics within 96 hr following administration
Limit exposure to articular cartilage due to potential risk of chondrolysis
Limitations of use
- Safety and efficacy not established in highly vascular surgeries (eg, intrathoracic, large multilevel spinal, and head and neck procedures)
Safety and efficacy not established
Consider dose reduction, particularly in those with reduced renal or hepatic function
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- sodium polystyrene sulfonate
meloxicam increases toxicity of sodium polystyrene sulfonate by Other (see comment). Contraindicated. Comment: Cases of intestinal necrosis (possibly fatal) described with concomitant sorbitol and sodium polystyrene sulfonate; due to sorbitol in meloxicam oral suspension, coadministration is not recommended.
Serious - Use Alternative (18)
- aminolevulinic acid oral
aminolevulinic acid oral, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
- aminolevulinic acid topical
meloxicam, aminolevulinic acid topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.
- apixaban
meloxicam and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.
- benazepril
meloxicam, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- bupivacaine implant
bupivacaine, bupivacaine implant. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid additional local anesthetic administration within 96 hr following bupivacaine implantation. If use of additional local anesthetics is unavoidable based on clinical need, monitor for neurologic and cardiovascular effects related to local anesthetic systemic toxicity.
bupivacaine, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia. - captopril
meloxicam, captopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- enalapril
meloxicam, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- fosinopril
meloxicam, fosinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ketorolac
meloxicam, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- ketorolac intranasal
meloxicam, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- lisinopril
meloxicam, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- methotrexate
meloxicam increases levels of methotrexate by decreasing renal clearance. Avoid or Use Alternate Drug. Concomitant administration of NSAIDs with high dose methotrexate has been reported to elevate and prolong serum methotrexate levels, resulting in deaths from severe hematologic and GI toxicity. NSAIDs may reduce tubular secretion of methotrexate and enhance toxicity. .
- methyl aminolevulinate
meloxicam, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.
- moexipril
meloxicam, moexipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- pemetrexed
meloxicam increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug. Interrupt dosing in all patients taking NSAIDs with long elimination half-lives for at least 5d before, the day of, and 2d following pemetrexed administration. If coadministration of an NSAID is necessary, closely monitor patients for toxicity, especially myelosuppression, renal toxicity, and GI toxicity.
- perindopril
meloxicam, perindopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ponesimod
ponesimod, bupivacaine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
- quinapril
meloxicam, quinapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
Monitor Closely (242)
- acebutolol
acebutolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of acebutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - aceclofenac
aceclofenac and meloxicam both increase anticoagulation. Use Caution/Monitor.
aceclofenac and meloxicam both increase serum potassium. Use Caution/Monitor. - acemetacin
acemetacin and meloxicam both increase anticoagulation. Use Caution/Monitor.
acemetacin and meloxicam both increase serum potassium. Use Caution/Monitor. - agrimony
meloxicam and agrimony both increase anticoagulation. Use Caution/Monitor.
- albuterol
meloxicam increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfalfa
meloxicam and alfalfa both increase anticoagulation. Use Caution/Monitor.
- alfuzosin
meloxicam decreases effects of alfuzosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- aliskiren
meloxicam will decrease the level or effect of aliskiren by Other (see comment). Use Caution/Monitor. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.
- alteplase
meloxicam and alteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- American ginseng
meloxicam and American ginseng both increase anticoagulation. Use Caution/Monitor.
- amiloride
amiloride and meloxicam both increase serum potassium. Modify Therapy/Monitor Closely.
- antithrombin alfa
antithrombin alfa and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- antithrombin III
antithrombin III and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- arformoterol
meloxicam increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- argatroban
argatroban and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- asenapine
meloxicam decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- aspirin
aspirin and meloxicam both increase anticoagulation. Use Caution/Monitor.
aspirin and meloxicam both increase serum potassium. Use Caution/Monitor. - aspirin rectal
aspirin rectal and meloxicam both increase anticoagulation. Use Caution/Monitor.
aspirin rectal and meloxicam both increase serum potassium. Use Caution/Monitor. - aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate and meloxicam both increase anticoagulation. Use Caution/Monitor.
aspirin/citric acid/sodium bicarbonate and meloxicam both increase serum potassium. Use Caution/Monitor. - atenolol
atenolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of atenolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - azficel-T
azficel-T, meloxicam. Other (see comment). Use Caution/Monitor. Comment: Patients taking anticoagulants may experience increased bruising or bleeding at biopsy and/or injection sites. Concomitant use of anticoagulants is not recommended. Decisions regarding continued use or cessation of anticoagulants should be made by a physician.
- azilsartan
meloxicam, azilsartan. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
meloxicam decreases effects of azilsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. - bemiparin
bemiparin and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- benazepril
benazepril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
bupivacaine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension. - bendroflumethiazide
meloxicam increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bupivacaine liposome
bupivacaine will increase the level or effect of bupivacaine liposome by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Bupivacaine HCl, when injected immediately before bupivacaine liposome, may impact the pharmacokinetic and/or physicochemical properties when the mg dose of bupivacaine HCl solution exceeds 50% of the bupivacaine liposome dose
- betaxolol
betaxolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of betaxolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - betrixaban
meloxicam, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.
- bimatoprost
bimatoprost, meloxicam. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- bisoprolol
bisoprolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of bisoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - bivalirudin
bivalirudin and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- budesonide
meloxicam, budesonide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- bumetanide
meloxicam increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
meloxicam decreases effects of bumetanide by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis. - candesartan
candesartan and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of candesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
candesartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - captopril
bupivacaine, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.
captopril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - carbenoxolone
meloxicam increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dofetilide
bupivacaine, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiac effects.
- carvedilol
carvedilol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - celecoxib
celecoxib and meloxicam both increase anticoagulation. Use Caution/Monitor.
celecoxib and meloxicam both increase serum potassium. Use Caution/Monitor. - celiprolol
celiprolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of celiprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - chlorothiazide
meloxicam increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpropamide
meloxicam increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- chlorthalidone
meloxicam increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cholestyramine
cholestyramine decreases levels of meloxicam by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
- choline magnesium trisalicylate
meloxicam and choline magnesium trisalicylate both increase anticoagulation. Use Caution/Monitor.
meloxicam and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor. - cinnamon
meloxicam and cinnamon both increase anticoagulation. Use Caution/Monitor.
- ciprofloxacin
meloxicam, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.
- citalopram
citalopram, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.
- clomipramine
clomipramine, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.
- clopidogrel
clopidogrel, meloxicam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- cordyceps
meloxicam and cordyceps both increase anticoagulation. Use Caution/Monitor.
- cortisone
meloxicam, cortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- cyclopenthiazide
meloxicam increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclosporine
meloxicam, cyclosporine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- dabigatran
dabigatran and meloxicam both increase anticoagulation. Use Caution/Monitor. Caution is advised, both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.
- dalteparin
dalteparin and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- deferasirox
deferasirox, meloxicam. Other (see comment). Use Caution/Monitor. Comment: Combination may increase GI bleeding, ulceration and irritation. Use with caution.
- defibrotide
defibrotide increases effects of meloxicam by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Defibrotide may enhance effects of platelet inhibitors.
- deflazacort
meloxicam, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- dexamethasone
meloxicam, dexamethasone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- diclofenac
diclofenac and meloxicam both increase anticoagulation. Use Caution/Monitor.
diclofenac and meloxicam both increase serum potassium. Use Caution/Monitor. - diflunisal
diflunisal and meloxicam both increase anticoagulation. Use Caution/Monitor.
diflunisal and meloxicam both increase serum potassium. Use Caution/Monitor. - digoxin
meloxicam and digoxin both increase serum potassium. Use Caution/Monitor.
- dobutamine
meloxicam increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dong quai
meloxicam and dong quai both increase anticoagulation. Use Caution/Monitor.
- dopexamine
meloxicam increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxazosin
meloxicam decreases effects of doxazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- drospirenone
drospirenone and meloxicam both increase serum potassium. Modify Therapy/Monitor Closely.
- duloxetine
duloxetine, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- edoxaban
edoxaban, meloxicam. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding, monitor closely. Promptly evaluate any signs or symptoms of blood loss.
- efavirenz
efavirenz will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.
- eltrombopag
eltrombopag increases levels of meloxicam by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF, meloxicam. Either increases toxicity of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of emtricitabine and tenofovir with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.
- emtricitabine
emtricitabine, meloxicam. Either increases levels of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of emtricitabine with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.
- enalapril
enalapril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- enoxaparin
enoxaparin and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- ephedrine
meloxicam increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
meloxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
meloxicam increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epoprostenol
meloxicam and epoprostenol both increase anticoagulation. Use Caution/Monitor.
- eprosartan
eprosartan and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of eprosartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
eprosartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - escitalopram
escitalopram, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- esmolol
esmolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ethacrynic acid
meloxicam increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- etodolac
etodolac and meloxicam both increase anticoagulation. Use Caution/Monitor.
etodolac and meloxicam both increase serum potassium. Use Caution/Monitor. - fennel
meloxicam and fennel both increase anticoagulation. Use Caution/Monitor.
- fenoprofen
fenoprofen and meloxicam both increase anticoagulation. Use Caution/Monitor.
fenoprofen and meloxicam both increase serum potassium. Use Caution/Monitor. - feverfew
meloxicam and feverfew both increase anticoagulation. Use Caution/Monitor.
- fish oil triglycerides
fish oil triglycerides will increase the level or effect of meloxicam by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.
- fludrocortisone
meloxicam, fludrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- fluoxetine
fluoxetine will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.
fluoxetine, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets. - flurbiprofen
flurbiprofen and meloxicam both increase anticoagulation. Use Caution/Monitor.
flurbiprofen and meloxicam both increase serum potassium. Use Caution/Monitor. - fluvoxamine
fluvoxamine, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding; SSRIs inhib. srotonin uptake by platelets.
- fondaparinux
fondaparinux and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- formoterol
meloxicam increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- forskolin
meloxicam and forskolin both increase anticoagulation. Use Caution/Monitor.
- fosinopril
fosinopril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- furosemide
meloxicam increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- garlic
meloxicam and garlic both increase anticoagulation. Use Caution/Monitor.
- gemifloxacin
gemifloxacin, meloxicam. Other (see comment). Modify Therapy/Monitor Closely. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.
- gentamicin
meloxicam increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ginger
meloxicam and ginger both increase anticoagulation. Use Caution/Monitor.
- ginkgo biloba
meloxicam and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.
- glimepiride
meloxicam increases effects of glimepiride by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glipizide
meloxicam increases effects of glipizide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glyburide
meloxicam increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- green tea
green tea, meloxicam. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.
- heparin
heparin and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- horse chestnut seed
meloxicam and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.
- hydralazine
meloxicam decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- hydrochlorothiazide
meloxicam increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydrocortisone
meloxicam, hydrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- ibrutinib
ibrutinib will increase the level or effect of meloxicam by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.
- ibuprofen
ibuprofen and meloxicam both increase anticoagulation. Use Caution/Monitor.
ibuprofen and meloxicam both increase serum potassium. Use Caution/Monitor. - ibuprofen IV
ibuprofen IV and meloxicam both increase anticoagulation. Use Caution/Monitor.
ibuprofen IV and meloxicam both increase serum potassium. Use Caution/Monitor. - icosapent
icosapent, meloxicam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time. Periodically monitor if coadministered with other drugs that affect bleeding.
- imatinib
imatinib will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.
imatinib, meloxicam. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents. - indapamide
meloxicam increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- indomethacin
indomethacin and meloxicam both increase anticoagulation. Use Caution/Monitor.
indomethacin and meloxicam both increase serum potassium. Use Caution/Monitor. - irbesartan
irbesartan and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of irbesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
irbesartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - isoproterenol
meloxicam increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketoprofen
ketoprofen and meloxicam both increase anticoagulation. Use Caution/Monitor.
ketoprofen and meloxicam both increase serum potassium. Use Caution/Monitor. - ketorolac
ketorolac and meloxicam both increase anticoagulation. Use Caution/Monitor.
ketorolac and meloxicam both increase serum potassium. Use Caution/Monitor. - ketorolac intranasal
ketorolac intranasal and meloxicam both increase anticoagulation. Use Caution/Monitor.
ketorolac intranasal and meloxicam both increase serum potassium. Use Caution/Monitor. - labetalol
labetalol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of labetalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - latanoprost
latanoprost, meloxicam. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- latanoprostene bunod ophthalmic
latanoprostene bunod ophthalmic, meloxicam. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- levalbuterol
meloxicam increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levofloxacin
levofloxacin, meloxicam. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.
- levomilnacipran
levomilnacipran, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.
- lisinopril
lisinopril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- lithium
meloxicam increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.
- lornoxicam
lornoxicam and meloxicam both increase anticoagulation. Use Caution/Monitor.
lornoxicam and meloxicam both increase serum potassium. Use Caution/Monitor. - losartan
losartan and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of losartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
losartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - meclofenamate
meclofenamate and meloxicam both increase anticoagulation. Use Caution/Monitor.
meclofenamate and meloxicam both increase serum potassium. Use Caution/Monitor. - mefenamic acid
mefenamic acid and meloxicam both increase anticoagulation. Use Caution/Monitor.
mefenamic acid and meloxicam both increase serum potassium. Use Caution/Monitor. - mesalamine
mesalamine, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive nephrotoxicity.
- metaproterenol
meloxicam increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methyclothiazide
meloxicam increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- methylprednisolone
meloxicam, methylprednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- metolazone
meloxicam increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metoprolol
metoprolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of metoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - milnacipran
milnacipran, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- mipomersen
mipomersen, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- mistletoe
meloxicam increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moexipril
moexipril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- moxifloxacin
moxifloxacin, meloxicam. Other (see comment). Modify Therapy/Monitor Closely. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.
- moxisylyte
meloxicam decreases effects of moxisylyte by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- mycophenolate
meloxicam will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- nabumetone
meloxicam and nabumetone both increase anticoagulation. Use Caution/Monitor.
meloxicam and nabumetone both increase serum potassium. Use Caution/Monitor. - nadolol
nadolol, bupivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
meloxicam decreases effects of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
nadolol and meloxicam both increase serum potassium. Use Caution/Monitor. - naproxen
meloxicam and naproxen both increase anticoagulation. Use Caution/Monitor.
meloxicam and naproxen both increase serum potassium. Use Caution/Monitor. - nevirapine
nevirapine will decrease the level or effect of bupivacaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nebivolol
nebivolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - nefazodone
nefazodone, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- nettle
meloxicam increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nevirapine
nevirapine will decrease the level or effect of meloxicam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- norepinephrine
meloxicam increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olmesartan
olmesartan and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of olmesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
olmesartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - oxaprozin
meloxicam and oxaprozin both increase anticoagulation. Use Caution/Monitor.
meloxicam and oxaprozin both increase serum potassium. Use Caution/Monitor. - panax ginseng
meloxicam and panax ginseng both increase anticoagulation. Use Caution/Monitor.
- parecoxib
meloxicam and parecoxib both increase anticoagulation. Use Caution/Monitor.
meloxicam and parecoxib both increase serum potassium. Use Caution/Monitor. - paroxetine
paroxetine, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- pau d'arco
meloxicam and pau d'arco both increase anticoagulation. Use Caution/Monitor.
- pegaspargase
pegaspargase increases effects of meloxicam by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.
- penbutolol
penbutolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - perindopril
perindopril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- phenindione
phenindione and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- phenoxybenzamine
meloxicam decreases effects of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- phentolamine
meloxicam decreases effects of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- phytoestrogens
meloxicam and phytoestrogens both increase anticoagulation. Use Caution/Monitor.
- pindolol
pindolol, bupivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
meloxicam decreases effects of pindolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
pindolol and meloxicam both increase serum potassium. Use Caution/Monitor. - pirbuterol
meloxicam increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- propranolol
propranolol, bupivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
- piroxicam
meloxicam and piroxicam both increase anticoagulation. Use Caution/Monitor.
meloxicam and piroxicam both increase serum potassium. Use Caution/Monitor. - pivmecillinam
pivmecillinam, meloxicam. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
pivmecillinam, meloxicam. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - potassium acid phosphate
meloxicam and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium chloride
meloxicam and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium citrate
meloxicam and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium iodide
potassium iodide and meloxicam both increase serum potassium. Use Caution/Monitor.
- pralatrexate
meloxicam increases levels of pralatrexate by decreasing renal clearance. Use Caution/Monitor. NSAIDs may delay pralatrexate clearance, increasing drug exposure. Adjust the pralatrexate dose as needed.
- prasugrel
meloxicam, prasugrel. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Chronic use of NSAIDs with prasugrel may increase bleeding risk.
- prazosin
meloxicam decreases effects of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- prednisolone
meloxicam, prednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- prednisone
meloxicam, prednisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- probenecid
meloxicam will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- propranolol
propranolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - protamine
protamine and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.
- quinapril
quinapril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ramipril
ramipril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- reishi
meloxicam and reishi both increase anticoagulation. Use Caution/Monitor.
- reteplase
meloxicam and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- rivaroxaban
rivaroxaban, meloxicam. Other (see comment). Use Caution/Monitor. Comment: NSAIDs are known to increase bleeding. Bleeding risk may be increased when NSAIDs are used concomitantly with rivaroxaban. Monitor for signs/symptoms of blood loss.
- rivastigmine
rivastigmine increases toxicity of meloxicam by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.
- sacubitril/valsartan
sacubitril/valsartan and meloxicam both increase serum potassium. Use Caution/Monitor.
sacubitril/valsartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
meloxicam decreases effects of sacubitril/valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. - salicylates (non-asa)
meloxicam and salicylates (non-asa) both increase anticoagulation. Use Caution/Monitor.
meloxicam and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor. - salmeterol
meloxicam increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salsalate
meloxicam and salsalate both increase anticoagulation. Use Caution/Monitor.
meloxicam and salsalate both increase serum potassium. Use Caution/Monitor. - saw palmetto
saw palmetto increases toxicity of meloxicam by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.
- sertraline
sertraline, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- Siberian ginseng
meloxicam and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.
- silodosin
meloxicam decreases effects of silodosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
meloxicam, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of meloxicam by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol
meloxicam, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of meloxicam by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sotalol
sotalol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - sparsentan
meloxicam and sparsentan both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Coadministration of NSAIDS, including selective COX-2 inhibitors, may result in deterioration of kidney function (eg, possible kidney failure). Monitor for signs of worsening renal function with concomitant use with NSAIDs.
- spironolactone
spironolactone and meloxicam both increase serum potassium. Modify Therapy/Monitor Closely.
- succinylcholine
meloxicam and succinylcholine both increase serum potassium. Use Caution/Monitor.
- sulfasalazine
meloxicam and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
meloxicam and sulfasalazine both increase serum potassium. Use Caution/Monitor. - sulindac
meloxicam and sulindac both increase anticoagulation. Use Caution/Monitor.
meloxicam and sulindac both increase serum potassium. Use Caution/Monitor. - tafluprost
tafluprost, meloxicam. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- telmisartan
telmisartan and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of telmisartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
telmisartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - temocillin
temocillin, meloxicam. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
temocillin, meloxicam. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - tenecteplase
meloxicam and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- tenofovir DF
tenofovir DF, meloxicam. Either increases levels of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of tenofovir DF with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.
- terazosin
meloxicam decreases effects of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- terbutaline
meloxicam increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ticagrelor
ticagrelor, meloxicam. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding with use of ticagrelor and chronic NSAID use. .
- ticarcillin
ticarcillin, meloxicam. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, meloxicam. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - timolol
meloxicam decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
timolol, bupivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
timolol and meloxicam both increase serum potassium. Use Caution/Monitor. - tolazamide
meloxicam increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- tolbutamide
meloxicam increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- tolfenamic acid
meloxicam and tolfenamic acid both increase anticoagulation. Use Caution/Monitor.
meloxicam and tolfenamic acid both increase serum potassium. Use Caution/Monitor. - tolmetin
meloxicam and tolmetin both increase anticoagulation. Use Caution/Monitor.
meloxicam and tolmetin both increase serum potassium. Use Caution/Monitor. - tolvaptan
meloxicam and tolvaptan both increase serum potassium. Use Caution/Monitor.
- torsemide
meloxicam increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trandolapril
trandolapril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- travoprost ophthalmic
travoprost ophthalmic, meloxicam. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- trazodone
trazodone, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- triamcinolone acetonide injectable suspension
meloxicam, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .
- triamterene
triamterene and meloxicam both increase serum potassium. Modify Therapy/Monitor Closely.
- valsartan
valsartan and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
valsartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - venlafaxine
venlafaxine, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- vitamin K1 (phytonadione)
meloxicam increases and vitamin K1 (phytonadione) decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- voclosporin
voclosporin, meloxicam. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
- vorapaxar
meloxicam, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur.
- vortioxetine
meloxicam, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.
- warfarin
meloxicam, warfarin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Drugs with antiplatelet properties may increase anticoagulation effect of warfarin.
- zanubrutinib
meloxicam, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.
- zotepine
meloxicam decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
Minor (51)
- aceclofenac
aceclofenac will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acemetacin
acemetacin will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acyclovir
meloxicam will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- alendronate
meloxicam, alendronate. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI ulceration.
- amikacin
meloxicam increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- aminohippurate sodium
meloxicam will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- amiodarone
amiodarone will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- amobarbital
amobarbital will decrease the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- anamu
meloxicam and anamu both increase anticoagulation. Minor/Significance Unknown.
- aspirin
aspirin will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin rectal
aspirin rectal will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- balsalazide
meloxicam will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- bendroflumethiazide
bendroflumethiazide will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- bosentan
bosentan will decrease the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- butabarbital
butabarbital will decrease the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- butalbital
butalbital will decrease the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- carbamazepine
carbamazepine will decrease the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- cefadroxil
cefadroxil will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefamandole
cefamandole will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefixime
cefixime will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefpirome
cefpirome will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ceftibuten
ceftibuten will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- celecoxib
celecoxib will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cephalexin
cephalexin will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorothiazide
chlorothiazide will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorpropamide
meloxicam will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorthalidone
chlorthalidone will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- choline magnesium trisalicylate
meloxicam will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- colestipol
colestipol decreases levels of meloxicam by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- creatine
creatine, meloxicam. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.
- cyclopenthiazide
cyclopenthiazide will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- danshen
meloxicam and danshen both increase anticoagulation. Minor/Significance Unknown.
- devil's claw
meloxicam and devil's claw both increase anticoagulation. Minor/Significance Unknown.
- diclofenac
diclofenac will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- diclofenac topical
diclofenac topical, meloxicam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Although low, there is systemic exposure to diclofenac topical; theoretically, concomitant administration with systemic NSAIDS or aspirin may result in increased NSAID adverse effects.
- diflunisal
diflunisal will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- disulfiram
disulfiram will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- eplerenone
meloxicam decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- etodolac
etodolac will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- etravirine
etravirine will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- felbamate
felbamate will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- fenoprofen
fenoprofen will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- feverfew
meloxicam decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.
- fluconazole
fluconazole will increase the level or effect of meloxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.
- flurbiprofen
flurbiprofen will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- furosemide
meloxicam decreases effects of furosemide by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- ganciclovir
meloxicam will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- gentamicin
meloxicam increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- hyaluronidase
hyaluronidase, bupivacaine. Other (see comment). Minor/Significance Unknown. Comment: Hyaluronidase hastens the onset of local analgesia and reduces swelling, but increases systemic absorption of anesthetic. This decreases the duration of action and increases incidence of systemic reaction.
- hydrochlorothiazide
hydrochlorothiazide will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
Adverse Effects
>10%
Bunionectomy
- Dizziness (22%)
- Incision site edema (17%)
- Headache (14%)
- Incision site erythema (13%)
- Herniorrhaphy H4
- Headache (13%)
Total knee arthroplasty
- Nausea (50%)
- Vomiting (26%)
- Constipation (24%)
- Hypertension (19%)
- Pyrexia (14%)
1-10%
Bunionectomy
- Bradycardia (8%)
- Impaired healing (6%)
- Muscle twitching (6%)
- Incision site cellulitis (4%)
- Wound dehiscence (4%)
- Incision site infection (3%)
Herniorrhaphy
- Bradycardia (9%)
- Dysgeusia (9%)
- Skin odor abnormal (8%)
Total knee arthroplasty
- Leukocytosis (7%)
- Pruritus (7%)
- Headache (7%)
- Headache (7%)
- Anemia (5%)
- Hyperhidrosis (5%)
- Hypotension (5%)
Warnings
Black Box Warnings
Cardiovascular risk
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), and stroke, which can be fatal
- Risk may increase with duration of use
- Patients with existing cardiovascular disease or risk factors for such disease may be at greater risk
- The risk of these events following single-dose local application of bupivacaine/meloxicam is uncertain
- Contraindicated in setting of coronary artery bypass graft (CABG) surgery
Gastrointestinal risk
- NSAIDs increase risk of serious GI adverse events, including bleeding, ulceration, and gastric or intestinal perforation, which can be fatal
- GI adverse events may occur at any time during use and without warning symptoms
- Geriatric patients and those with prior history of peptic ulcer disease and/or GI bleeding are at greater risk
Contraindications
Known hypersensitivity (eg, anaphylactic reactions, serious skin reactions) to any local anesthetic agent of the amide-type, NSAIDs, or to any of the other components
History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs; severe, sometimes fatal, anaphylactic reactions to NSAIDs reported
Patients undergoing obstetrical paracervical block anesthesia; use of bupivacaine in this technique has resulted in fetal bradycardia and death
Patients undergoing coronary artery bypass graft (CABG) surgery
Cautions
Hepatotoxicity
- Amide-type local anesthetics (eg, bupivacaine) are metabolized by the liver; use cautiously with hepatic impairment
- Increased ALT/AST ≥3x ULN reported (rarely) with NSAID use; rare, sometimes fatal, cases of severe hepatic injury, including fulminant hepatitis, liver necrosis, and hepatic failure, reported
- Inform patients of warning signs and symptoms of hepatotoxicity (eg, nausea, fatigue, lethargy, diarrhea, pruritus, jaundice, right upper quadrant tenderness, and “flu-like” symptoms); if clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (eg, eosinophilia, rash), promptly evaluate the patient
Bupivacaine
- Prevent dose-related toxicity by assuring proper dose and correct technique
- Limit exposure to articular cartilage due to the potential risk of chondrolysis
- Chondrolysis reported with intra-articular infusion of local anesthetics; intra-articular infusions of local anesthetics, following arthroscopic and other surgical procedures is an unapproved use
Meloxicam
-
Anaphylaxis and aspirin-sensitive asthma
- May cause anaphylactic reactions in patients with and without known hypersensitivity to meloxicam and in patients with aspirin-sensitive asthma
- A subpopulation of patients with asthma may have aspirin-sensitive asthma including severe, potentially fatal bronchospasm; these patients also may may have intolerance to other NSAIDs
- These patients may also be intolerant to other NSAIDs; when used in patients with preexisting asthma (without known aspirin sensitivity), monitor patients for exacerbation of asthma symptoms
-
Cardiovascular events
- Cardiovascular thrombotic events reported with NSAID use
- Avoid use post myocardial infarction unless benefits outweigh risk; contraindicated in first 10-14 days following CABG
- Avoid use with severe heart failure unless benefits outweigh risk of worsening heart failure
- Fluid retention and edema observed in some patients taking NSAIDs
-
Hypertension
- NSAIDs may impair response to loop and thiazide diuretics; monitor blood pressure
- May lead to new-onset hypertension or exacerbate existing hypertension
-
GI bleeding, ulceration, and perforation
- Anemia reported in NSAID-treated patients; this may be due to occult or gross blood loss, fluid retention, or an incompletely described effect on erythropoiesis
- Monitor hemoglobin or hematocrit if signs or symptoms of anemia occur
-
Renal toxicity and hyperkalemia
- Long-term administration of NSAIDs has resulted in renal papillary necrosis, renal insufficiency, acute renal failure, and other renal injury
- Increases in serum potassium concentration, including hyperkalemia, reported with NSAIDs, even in some patients without renal impairment
- NSAIDs may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation; patients at greatest risk of this reaction are those with impaired renal function, dehydration, hypovolemia, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors or ARBs, and the elderly; these effects are reversible upon discontinuation of the NSAID
- Meloxicam may hasten progression of renal dysfunction in patients with preexisting renal disease; because some meloxicam metabolites are excreted by the kidney, monitor patients for signs of worsening renal function; correct volume status in dehydrated or hypovolemic patients prior to initiating therapy
-
Skin reactions
- NSAIDs can cause serious adverse reactions (eg, exfoliative dermatitis, Stevens-Johnson Syndrome [SJS], toxic epidermal necrolysis [TEN], eosinophilia and systemic symptoms [DRESS] syndrome), which can be fatal
- These serious events may occur without warning; inform patients about signs and symptoms of serious skin reactions
- DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy, and/or facial swelling; other clinical manifestations may include hepatitis, nephritis, hematological abnormalities, myocarditis, or myositis; sometimes symptoms of DRESS may resemble an acute viral infection; eosinophilia is often present; disorder is variable in its presentation, other organ systems not noted here may be involved; early manifestations of hypersensitivity, such as fever or lymphadenopathy may be present even though rash is not evident; if such signs or symptoms are present, evaluate the patient immediately and treat as clinically indicated
-
Methemoglobinemia
- Although all patients are at risk for methemoglobinemia, patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition; if local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia recommended
- Signs of methemoglobinemia may occur immediately or may be delayed some hours after exposure and are characterized by a cyanotic skin discoloration and/or abnormal coloration of the blood; methemoglobin levels may continue to rise; therefore, immediate treatment is required to avert more serious central nervous system and cardiovascular adverse effects, including seizures, coma, arrhythmias, and death
- Discontinue any oxidizing agents; depending on severity of signs and symptoms, patients may respond to supportive care, ie, oxygen therapy, hydration; a more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen
-
Masking of inflammation and fever
- May reduce utility of diagnostic signs in detecting infection by reducing inflammation and fever
-
Fetal toxicity
- NSAIDs may cause premature closure of fetal ductus arteriosus, oligohydramnios, and neonatal renal impairment
Drug interaction overview
-
Other local anesthetics
- If unable to avoid coadministration, monitor for neurologic and cardiovascular adverse effects
- Toxic effects of local anesthetics are additive; avoid additional local anesthetic within 96 hr after bupivacaine/meloxicam administration
-
Drug-associated methemoglobinemia
- Avoid coadministration of bupivacaine with other drugs that increase risk of methemoglobinemia
- Examples of such drugs include nitrates/nitrites (eg, nitric oxide, nitroglycerin, nitroprusside, nitrous oxide); other local anesthetic; certain antineoplastic agents (eg, cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase); certain antibiotics (eg, dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides); antimalarials (eg, chloroquine, primaquine); anticonvulsants (eg, phenobarbital, phenytoin, sodium valproate); and other drugs (eg, acetaminophen, metoclopramide, quinine, sulfasalazine)
-
Drugs interfering with hemostasis
- Monitor if coadministered
- Coadministration of NSAIDs with anticoagulants (eg, warfarin), antiplatelet agents (eg, aspirin), or drugs that inhibit serotonin (eg, SSRIs, SNRIs) may increases risk of bleeding
-
Aspirin
- Monitor for signs and symptoms of GI bleeding
- Coadministration of NSAIDs and aspirin associated with increased incidence of GI adverse effects compared with when an NSAID is used alone
-
ACE inhibitors, angiotensin receptor blockers (ARBs), beta-blockers
- Monitor blood pressure, volume, renal function
- NSAIDs may decrease antihypertensive effect of ACE inhibitors, ARBs, or beta-blockers
- Coadministration of NSAIDs with ACE inhibitors or ARBs may result in deterioration of renal function, including possible acute renal failure, particularly in patients who are elderly, volume-depleted (including those on diuretic therapy), or have renal impairment
-
Effect of NSAIDS on selected drugs
- Monitor serum levels (if applicable) and adverse effects
- Digoxin: Coadministration may increase digoxin serum levels
- Lithium: Coadministration may increase plasma lithium levels
- Methotrexate: Coadministration may increase risk for methotrexate toxicity (eg, neutropenia, thrombocytopenia, renal dysfunction)
- Cyclosporine: Coadministration may increase cyclosporine-associated nephrotoxicity
- Pemetrexed: Coadministration may increase risk of pemetrexed-associated myelosuppression, renal, and GI toxicity
Pregnancy & Lactation
Pregnancy
Data are unavailable on use of bupivacaine/meloxicam in pregnant females to evaluate drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes; however, data are available on the individual components
Bupivacaine
- There are no studies conducted with pregnant females
-
Animal studies
- Embryofetal deaths were observed with SC administration of bupivacaine to rabbits during organogenesis at a dose equivalent to 1.6 times the maximum recommended human dose (MRHD) of 266 mg; SC administration of bupivacaine to rats from implantation through weaning produced decreased pup survival at a dose equivalent to 1.5 times the MRHD
- Advise pregnant females of the potential risks to a fetus
Meloxicam
- Data from observational studies regarding potential embryofetal risks of NSAID use in women in the first or second trimesters of pregnancy are inconclusive
-
Fetal toxicity
- Avoid use of NSAIDs in pregnant women at about 30 weeks' gestation and later; NSAIDs increase risk of premature closure of fetal ductus arteriosus at approximately this gestational age
- Use of NSAIDs at about 20 weeks' gestation or later in pregnancy may also cause fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment
- These adverse outcomes are seen, on average, after days to weeks of treatment, although oligohydramnios has been infrequently reported as soon as 48 hours after NSAID initiation
- Oligohydramnios is often, but not always, reversible with treatment discontinuation; complications of prolonged oligohydramnios may, for example, include limb contractures and delayed lung maturation
- In some postmarketing cases of impaired neonatal renal function, invasive procedures such as exchange transfusion or dialysis were required
- If NSAID treatment is necessary between about 20 and 30 weeks' gestation, limit use to the lowest effective dose and shortest duration possible
- Consider ultrasound monitoring of amniotic fluid if treatment extends beyond 48 hours; discontinue drug if oligohydramnios occurs and follow up according to clinical practice
-
Animal studies
- Based on animal data, prostaglandins have been shown to have an important role in endometrial vascular permeability, blastocyst implantation, and decidualization
- Administration of prostaglandin synthesis inhibitors, such as meloxicam, resulted in increased preimplantation and postimplantation loss
Infertility
-
Females
- Based on the mechanism of action, prostaglandin-mediated NSAIDs may delay or prevent rupture of ovarian follicles, which has been associated with reversible infertility in some women
- Animal studies have shown prostaglandin synthesis inhibitors may disrupt prostaglandin-mediated follicular rupture required for ovulation
- Small studies in women treated with NSAIDs have also shown a reversible delay in ovulation
- Consider withdrawal/avoidance of NSAIDs in women who have difficulties conceiving or who are undergoing infertility investigation
-
Males
- Male rats given meloxicam PO for 35 days had decreased sperm count and motility, and histopathological evidence of testicular degeneration at 0.8 times the MRHD based on BSA comparison
Lactation
Data are unavailable on whether drug is present in human milk, or on the effects on breastfed infants, or on milk production
Animal data
- Meloxicam is present in milk of lactating rats at concentrations higher than those in plasma
- Bupivacaine and meloxicam detected in milk of lactating pigs, but only bupivacaine was detected in plasma of piglets
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Bupivacaine: Local amide anesthetic; blocks generation and conduction of nerve impulses presumably by increasing the electrical excitation threshold in the nerve, by slowing nerve impulse propagation, and by reducing the rate of action potential rise
Meloxicam: Member of oxicam class; inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclooxygenase (COX) isoenzymes, COX-1 and COX-2
Absorption
Peak plasma time
-
Bunionectomy
- Bupivacaine: 3 hr
- Meloxicam: 18 hr
-
Herniorrhaphy
- Bupivacaine: 18 hr
- Meloxicam: 54 hr
-
Total knee arthroplasty
- Bupivacaine: 21 hr
- Meloxicam: 36 hr
Peak plasma concentration
- Systemic plasma levels of bupivacaine or meloxicam following application do not correlate with local efficacy
-
Bunionectomy
- Bupivacaine: 54 ng/mL
- Meloxicam: 26 ng/mL
-
Herniorrhaphy
- Bupivacaine: 271 ng/mL
- Meloxicam: 225 ng/mL
-
Total knee arthroplasty
- Bupivacaine: 695 ng/mL
- Meloxicam: 275 ng/mL
AUC
-
Bunionectomy
- Bupivacaine: 1,718 hng/mL
- Meloxicam: 2,079 hng/mL
-
Herniorrhaphy
- Bupivacaine: 15,524 hng/mL
- Meloxicam: Not reported
-
Total knee arthroplasty
- Bupivacaine: 38,173 hng/mL
- Meloxicam: 19,525 hng/mL
Distribution
After bupivacaine and meloxicam have been released and are absorbed systemically, their distribution is expected to be as other bupivacaine formulations or meloxicam oral formulation
Bupivacaine
- Depending on route of administration, distribution to some extent to all body tissues, with high concentrations found in highly perfused organs such as the liver, lungs, heart, and brain
Meloxicam
- Protein bound: 99.4%; primarily to albumin
- Vd: ~10 L
Metabolism
Bupivacaine
- Metabolized primarily by the liver via conjugation with glucuronic acid
- Metabolites: ~5% converted to the major metabolite, pipecolylxylidine
Meloxicam
- Metabolized in liver by CYP2C9 (major) and CYP3A4 (minor)
- Metabolites (inactive): 5'-Carboxy meloxicam, 5'-hydroxymethyl meloxicam
Elimination
Half-life
- Bupivacaine: 14-15 hr
- Meloxicam: 22-25 hr
Excretion
- Bupivacaine: Mainly excreted by kidneys; 6% unchanged in urine
- Meloxicam: Predominately excreted as metabolites equally between urine and feces
Pharmacogenomics
CYP2C9 activity reduced in individuals with genetic variants (eg, CYP2C9*2 and CYP2C9*3 polymorphisms)
Limited data found meloxicam
Administration
Incompatibilities
Bupivacaine/meloxicam is a nonaqueous solution; do not mix with water, saline, or other local anesthetics as the product will become more viscous and difficult to administer
Topical antiseptic, such as povidone iodine solution; allow antiseptic to dry before local anesthetic administered into site
When administered in recommended doses and concentrations, does not ordinarily produce irritation or tissue damage
Compatibilities
Compatible with all components in the kit, including syringes, Luer lock applicators, vented vial spike, and syringe tip caps
Surgical mesh materials, including polypropylene (Prolene), Gore-Tex, and polyester
Silicone membranes
Bone cement
Metal alloys used in surgical implants
Soft-Tissue or Periarticular Instillation
Follow instructions in kit and only use supplied syringes and applicators
Apply solution without a needle into the surgical site following final irrigation and suctioning, and prior to suturing of each layer, when multiple tissue layers are involved
When bupivacaine/meloxicam comes in contact with moisture in tissues, it becomes more viscous, allowing it to stay in place
Does not degrade sutures; when using monofilament sutures, ≥3 knots recommended; contact with bupivacaine/meloxicam may cause a single knot to loosen or untie
Do NOT administer by following routes: Epidural, intrathecal, intravascular or intra-articular, regional nerve blocks, or preincisional or preprocedural locoregional anesthetic techniques
Limit exposure to articular cartilage due to potential risk of chondrolysis
Only apply to tissue layers below the skin incision and not directly onto subdermal layer or the skin
Use only amount necessary to coat the tissues, such that bupivacaine/meloxicam does not leak from surgical wound after closure
Potential risk of severe, life-threatening neurological or cardiac toxicity associated with bupivacaine; administer in setting where trained personnel and equipment are available
Storage
Store kit in carton at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)
Protect from moisture and light
If vial removed from kit, store at controlled room temperature and protect from light
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Zynrelef surgical site instillation - | 400 mg-12 mg /14 mL solution |  |
Copyright © 2010 First DataBank, Inc.
Formulary
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