From the Guidelines
It is not recommended to take aspirin and meloxicam together without medical supervision due to the increased risk of gastrointestinal bleeding, ulcers, and kidney problems. The combination of these two non-steroidal anti-inflammatory drugs (NSAIDs) can also raise blood pressure and increase cardiovascular risks, as both medications work by inhibiting prostaglandin production through the blockade of cyclooxygenase enzymes, leading to overlapping effects and side effects 1. When considering the use of aspirin and meloxicam together, it's essential to weigh the benefits against the potential risks, particularly in patients with a history of peptic ulcer disease, gastrointestinal bleeding, or those taking anticoagulant therapy, as the risk of upper gastrointestinal tract bleeding and perforation is increased 1. Some key points to consider include:
- The risk of gastrointestinal bleeding is higher when NSAIDs are used concomitantly with aspirin, with studies indicating that the odds ratio for bleeding can range from 1.6 with low-dose aspirin to 5.6 when combined with a non-selective NSAID 1.
- The FDA cautions that the concomitant use of an NSAID with aspirin may reduce the cardioprotective efficacy of aspirin and increase the risk of gastrointestinal bleeding 1.
- Patients older than 60 years or those with compromised fluid status, renal insufficiency, or concomitant use of other medications that may increase the risk of side effects should be prescribed NSAIDs with caution 1. If you're taking low-dose aspirin for heart protection and need to add meloxicam for pain management, it's crucial to discuss this with your healthcare provider to determine the best course of action, which may include adjusting your treatment plan or taking the medications at different times to minimize the risk of adverse effects 1.
From the Research
Interaction Between Aspirin and Meloxicam
- The interaction between aspirin and meloxicam has been studied in a clinical setting 2.
- According to the study, concurrent treatment with aspirin increased plasma concentrations of meloxicam, increasing the maximum plasma concentration (Cmax) by approximately 25% and the area under the plasma concentration-time curve (AUC0-infinity) by 10% 2.
- However, these differences were not considered to be clinically relevant, and no adjustments of meloxicam dose should be required with coadministration of aspirin 2.
Considerations for Combination Use
- Combination use of nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and meloxicam, might be discouraged due to several reasons, including reduced blood levels of NSAIDs and lack of clinical data to suggest benefits 3.
- The use of NSAIDs, including meloxicam, can increase the risk of gastrointestinal complications, and the presence of factors like advanced age, history of peptic ulcer, and use of anticoagulants or antiplatelet agents can further increase this risk 4.
- Concomitant use of low-dose aspirin with any NSAID, including meloxicam, increases the risk of gastrointestinal complications and diminishes the improved gastrointestinal safety profile of some NSAIDs 5.
Gastrointestinal Safety
- The use of proton pump inhibitors (PPIs) or selective cyclo-oxygenase (COX)-2 inhibitors can help minimize the risk of gastrointestinal complications in high-risk patients 6, 4.
- Evidence suggests that concurrent use of a non-selective NSAID plus a PPI is as effective in preventing NSAID gastropathy as COX-2 inhibitors, and may be more cost-effective 5.