Can I take meloxicam (Mobic) while on Eliquis (apixaban)?

Concurrent Use of Meloxicam and Eliquis (Apixaban)

Taking meloxicam while on Eliquis (apixaban) is not recommended due to increased bleeding risk when NSAIDs are combined with direct oral anticoagulants.

Mechanism of Interaction

The combination of meloxicam (an NSAID) with apixaban creates a concerning drug interaction for the following reasons:

• Apixaban's drug label explicitly states that "coadministration of antiplatelet agents, fibrinolytics, heparin, aspirin, and chronic NSAID use increases the risk of bleeding" 1
• NSAIDs like meloxicam can cause gastric irritation and increase the risk of gastrointestinal bleeding
• The anticoagulant effect of apixaban combined with the antiplatelet effect of meloxicam creates a synergistic bleeding risk

Evidence from Clinical Trials

In the ARISTOTLE trial, concomitant use of aspirin (another antiplatelet agent) increased the bleeding risk on apixaban from 1.8% per year to 3.4% per year 1. While this specific study examined aspirin rather than meloxicam, the mechanism of increased bleeding risk applies to NSAIDs as a class.

Management Algorithm

1. First-line approach: Avoid the combination of meloxicam and apixaban whenever possible

   • Consider acetaminophen as an alternative analgesic
   • If pain control is inadequate, consider topical NSAIDs which have less systemic absorption

2. If NSAID therapy is absolutely necessary:

   • Use the lowest effective dose of meloxicam (7.5mg rather than 15mg)
   • Limit duration of therapy to shortest possible course
   • Consider gastroprotection with a proton pump inhibitor
   • Monitor closely for signs of bleeding (bruising, black stools, hematemesis)
   • Be vigilant for decreased hemoglobin levels

3. High-risk patients who should absolutely avoid this combination:

   • History of GI bleeding or peptic ulcer disease
   • Concurrent use of other antiplatelet agents (e.g., aspirin, clopidogrel)
   • Elderly patients (>75 years)
   • Renal impairment
   • History of stroke

Special Considerations

• Meloxicam has a long half-life of approximately 20 hours 2, which means the bleeding risk may persist even after discontinuation
• While meloxicam is considered to have a more favorable GI safety profile than some other NSAIDs 3, this advantage is likely negated when combined with anticoagulants
• Thrombocytopenia has been reported as a rare adverse effect of meloxicam 4, which could further increase bleeding risk in combination with apixaban

Monitoring Recommendations

If the combination cannot be avoided:

• Monitor for signs of bleeding (overt bleeding, bruising, black stools)
• Check complete blood count periodically
• Monitor renal function as deterioration could increase apixaban levels
• Educate patient about signs and symptoms of bleeding that warrant immediate medical attention

Remember that the risk of serious bleeding complications outweighs the potential benefits of combining these medications in most clinical scenarios.