Meloxicam interactions: what you shouldn't mix with this drug

Some foods just don't go together. Peanut butter and ketchup? No thanks. Pineapple on pizza? The jury's still out on that one. But whether Hawaiian pizza is your thing or not, it's not just a matter of taste when it comes to medications. Some things just shouldn't be mixed. 

Meloxicam is a prescription NSAID (non-steroidal anti-inflammatory drug). That's the same type of medication as over-the-counter painkillers like Advil and naproxen, and it's typically used to treat conditions characterized by pain and swelling, like joint inflammation in arthritis. And while all by itself, meloxicam can cause some serious side effects, especially if you take it for an extended period of time, combining meloxicam with other medications can increase your risk of experiencing adverse effects.  

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Meloxicam may affect how well drugs that lower blood pressure work. Blood pressure medications like ACE inhibitors, angiotensin receptor blockers (ARBs), or beta-blockers may be less effective if taken with meloxicam (Fournier, 2012; Johnson, 1994). 

Meloxicam may have the same effect on other medications such as diuretics (aka "water pills"), drugs used to stop fluid retention or lower high blood pressure. Loop diuretics such as furosemide and thiazide diuretics such as hydrochlorothiazide (HCTZ) may not work as well if taken with meloxicam. If taken together, these medications may also worsen kidney function, potentially causing kidney failure (DailyMed, 2019).

Meloxicam may also increase the toxic effect certain medications have on the kidneys. Taking meloxicam with these medications, such as cyclosporine, may increase the risk of kidney damage or kidney failure. Meloxicam interferes with the way our bodies remove medications from our bloodstream. That's why taking meloxicam may result in higher blood levels of other medications you're taking. 

One example of this is methotrexate, another drug that can be used to treat certain types of arthritis and certain types of cancers. Elevated levels of methotrexate can cause serious adverse effects (FDA, 2012).

Certain medications may put you at an increased risk of bleeding if taken with meloxicam. Meloxicam interferes with normal platelet function, compromising your platelets' ability to clump together to create blood clots. Taking meloxicam increases the time it takes your blood to clot (Rinder, 2002; Martini, 2014). 

Blood thinners (such as the anticoagulant warfarin) also prevent clotting, so taking them with meloxicam increases your risk of bleeding. Other medications, including antiplatelet agents (like aspirin), may also increase bleeding risk when taken with meloxicam (DailyMed, 2019). Smoking while taking meloxicam also increases your risk of bleeding problems (FDA, 2012).

NSAIDs all interfere with the protective lining of your stomach, especially when used for a long period of time (Wallace, 2000). Combining meloxicam with other NSAIDs (such as non-prescription NSAIDs, naproxen, or ibuprofen) further interferes with this protection and increases the chance of developing gastrointestinal problems like stomach ulcers or bleeding.

Meloxicam is a prescription NSAID approved to manage the pain and swelling associated with inflammatory conditions. It's frequently used for specific types of joint pain in conditions like osteoarthritis (OA) and rheumatoid arthritis (RA). 

It can also be used off-label, in a way not specifically approved by the U.S. Food and Drug Administration (FDA), to treat a joint condition called gout. None of these conditions, characterized by inflammation in the joints, can be cured—but NSAIDs such as meloxicam can manage the pain.

• Osteoarthritis (OA) is the most common type of arthritis that's typically associated with wear and tear on the joints. It causes redness, pain, swelling, and joint deformities that can make it hard to function. More than 43 million people around the world suffer from moderate-to-severe osteoarthritis. Genetics, history of injury, increased body weight, other underlying conditions may increase your risk of developing OA, and it becomes more common as we age. Signs of this disease are present in more than 80% of people over the age of 60 (Sen, 2020). 

• Rheumatoid arthritis (RA) is caused by the immune system inappropriately attacking certain areas of the body, including the joints, the lungs, and other tissues. Treatment for RA involves NSAIDs as well as other immune-suppressing drugs like steroids. NSAIDs such as meloxicam can help quell the immune response and alleviate pain, especially since rest doesn't help. Rest often improves the symptoms of osteoarthritis but exacerbates the pain and stiffness associated with rheumatoid arthritis. 

• Gout is characterized by sudden pain, redness, and swelling of joints. It may affect any joint in the body but commonly affects the big toe. Gout often results from a buildup of uric acid in the body, but behavioral factors can trigger flare-ups or attacks in susceptible individuals (Jin, 2012). These factors include certain foods, like shellfish and red meat, and drugs, like aspirin and certain diuretics ("water pills"), which increase the levels of uric acid in the body (ACR, 2019). Meloxicam can help manage gout symptoms such as pain and swelling (Gaffo, 2019).

• Meloxicam has also been used off-label to manage the pain associated with ankylosing spondylitis (AS), a rare, chronic inflammatory condition that affects the spine (Song, 2008). Like OA and RA, AS currently has no cure, but NSAIDs such as meloxicam can help manage the pain.

The most common side effects of meloxicam are diarrhea, indigestion, and flu-like symptoms (FDA, 2012). Other possible side effects include headache, dizziness, skin rash, and other gastrointestinal issues such as heartburn, nausea, and gas (DailyMed, 2019).

The FDA issued a "black box" warning about this medication's serious potential side effects on the gastrointestinal (GI) system. Meloxicam can increase your risk of serious GI symptoms, including bleeding, ulcerations, and perforations in the stomach or intestines. These conditions may occur without warning, may be fatal, and are more likely to happen in certain at-risk people, such as older people and those with a prior history of GI problems (FDA, 2012). Note that this drug does not need to be taken by mouth to cause digestive problems. It does the same when administered as an injection.

Non-steroidal anti-inflammatory drugs (NSAIDs) act on different parts of the inflammation pathway to decrease symptoms such as swelling. One result of this is that meloxicam interferes with normal platelet function, which may increase your risk of bleeding (Rinder, 2002).

Meloxicam is sold as a generic drug as well as under the brand names Mobic and Vivlodex. Generic meloxicam is sometimes referred to as generic Mobic. Meloxicam doses for both generic and brand-name tablets are 5 mg, 7.5 mg, 10 mg, and 15 mg dosages. There are multiple forms of this medication. Forms of this medication include meloxicam oral suspension (7.5 mg/5 ml), a disintegrating tablet (7.5 mg and 15 mg dosages), and an intravenous (IV) solution (30 mg/mL). IV meloxicam is used in a hospital setting.

Most people usually take one pill by mouth daily. If you miss a dose, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and take your next dose as usual. Don't take a double dose. You should store meloxicam tablets at room temperature and out of the reach of children.

Many insurance plans cover meloxicam—a 30-day supply costs between $4 to over $400 (GoodRx.com). The price depends on the strength and whether you purchase brand name or generic pills. 

The FDA issued a black box warning about the serious side effects of meloxicam. A black box warning is the FDA's most serious advisory on a medication, which comes in the insert for some prescription drugs.

Meloxicam may increase the risk of heart attacks and strokes, especially in people with heart disease or other cardiovascular risk factors. This risk may be higher if you use meloxicam long-term. Do not use meloxicam to treat pain right before or after heart surgery, like a coronary artery bypass graft (CABG) procedure. Meloxicam can also put you at a greater risk of gastrointestinal bleeding, stomach ulcers, or holes (perforations) in the stomach or intestines (FDA, 2012).  

NSAIDs such as meloxicam should also not be taken during the third trimester of pregnancy. These medications may interfere with how the fetus's heart develops and redirect blood flow in the fetus's body, which may result in progressive heart problems later on (Bloor, 2013; Enzensberger, 2012). 

If you're breastfeeding, discuss meloxicam use with a medical professional. It isn't known if this medication gets into breastmilk. A healthcare professional can help weigh the benefits of using this medication while nursing (FDA, 2012). People who are or wish to become pregnant should get medical advice about using NSAIDs. NSAID use may affect the embryo's ability to implant in the uterus, which may mean it's necessary to discontinue their use in individuals having a hard time getting pregnant (Bermas, 2014). 

It is possible to have an allergic reaction to meloxicam (Domingo, 2006). You shouldn't take this prescription drug if you're allergic to any of its ingredients. Get medical help right away if you experience any signs of an allergic reaction, including serious skin reactions such as a rash with blisters or hives, shortness of breath, or facial swelling.

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Current version

May 12, 2021

Written by

Linnea Zielinski

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.