DRUG INTERACTIONS
See also Clinical Pharmacology .
ACE-inhibitors
NSAIDs may diminish the antihypertensive
effect of ACE-inhibitors. This interaction should be given consideration
in patients taking MOBIC concomitantly with ACE-inhibitors.
Aspirin
When MOBIC is administered with aspirin
(1000 mg three times daily) to healthy volunteers, an increase in
the AUC (10%) and Cmax (24%) of meloxicam was
noted. The clinical significance of this interaction is not known;
however, as with other NSAIDs concomitant administration of meloxicam
and aspirin is not generally recommended because of the potential
for increased adverse effects.
Concomitant administration of low-dose aspirin with MOBIC may result
in an increased rate of GI ulceration or other complications, compared
to use of MOBIC alone. MOBIC is not a substitute for aspirin for cardiovascular
prophylaxis.
Diuretics
Clinical studies, as well as post marketing
observations, have shown that NSAIDs can reduce the natriuretic effect
of furosemide and thiazides in some patients. This response has been
attributed to inhibition of renal prostaglandin synthesis. However,
studies with furosemide agents and meloxicam have not demonstrated
a reduction in natriuretic effect. Furosemide single and multiple
dose pharmacodynamics and pharmacokinetics are not affected by multiple
doses of meloxicam. Nevertheless, during concomitant therapy with
MOBIC, patients should be observed closely for signs of renal failure
[
see Warnings and Precautions
], as well as to ensure diuretic
efficacy.
Lithium
In a study conducted in healthy subjects,
mean pre-dose lithium concentration and AUC were increased by 21%
in subjects receiving lithium doses ranging from 804 to 1072 mg twice
daily with meloxicam 15 mg every day as compared to subjects receiving
lithium alone. These effects have been attributed to inhibition of
renal prostaglandin synthesis by MOBIC. Closely monitor patients on
lithium treatment for signs of lithium toxicity when MOBIC is introduced,
adjusted, or withdrawn.
Methotrexate
NSAIDs have been reported to competitively
inhibit methotrexate accumulation in rabbit kidney slices. Therefore,
NSAIDs may reduce the elimination of methotrexate, thereby enhancing
the toxicity of methotrexate. Use caution when MOBIC is administered
concomitantly with methotrexate [
see Clinical Pharmacology
].
Cyclosporine
MOBIC, like other NSAIDs, may affect renal
prostaglandins, thereby altering the renal toxicity of certain drugs.
Therefore, concomitant therapy with MOBIC may increase cyclosporine's
nephrotoxicity. Use caution when MOBIC is administered concomitantly
with cyclosporine.
Warfarin
The effects of warfarin and NSAIDs on GI
bleeding are synergistic, such that users of both drugs together have
a risk of serious GI bleeding higher than users of either drug alone.
Monitor anticoagulant activity, particularly
in the first few days after initiating or changing MOBIC therapy in
patients receiving warfarin or similar agents, since these patients
are at an increased risk of bleeding than with the use of either drug
alone. Use caution when administering MOBIC with warfarin since patients
on warfarin may experience changes in INR and an increased risk of
bleeding complications when a new medication is introduced [
see Clinical Pharmacology
].
Kayexalate® (sodiumpolystyrene sulfonate)
Cases of intestinal necrosis (possibly fatal) have been described
in patients who received concomitant sorbitol and Kayexalate® (sodium
polystyrene sulfonate). Due to the presence of sorbitol in MOBIC
Oral Suspension, use with Kayexalate® is not recommended.
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