Can you take Mobic (meloxicam) with methotrexate?

Concurrent Use of Mobic (Meloxicam) with Methotrexate

Mobic (meloxicam) can be taken with methotrexate, but requires careful monitoring due to potential increased risk of methotrexate toxicity. 1

Safety Considerations

• NSAIDs including meloxicam can reduce renal elimination of methotrexate, potentially increasing methotrexate blood levels and toxicity 1
• The British Journal of Dermatology specifically lists NSAIDs among drugs that may increase methotrexate toxicity through reduced renal elimination 1
• Despite these concerns, a 2014 study specifically examining meloxicam with methotrexate found that concomitant use did not clearly increase the risk of silent kidney or liver damage in rheumatoid arthritis patients with normal baseline laboratory results 2
• This combination is commonly used in rheumatologic practice with appropriate monitoring 2

Monitoring Recommendations

• More frequent monitoring of liver function tests (LFTs) and complete blood count (CBC) is recommended when using this combination 1
• Standard monitoring for methotrexate includes:
  • CBC, LFTs, and renal function tests within the first 1-2 months of usage 1
  • Continued monitoring every 3-4 months thereafter 1
• When adding meloxicam, consider:
  • More frequent monitoring initially (every 2-4 weeks for the first few months) 1
  • Particular attention to renal function tests, as NSAIDs can affect methotrexate elimination 1

Risk Mitigation Strategies

• Folic acid supplementation is strongly recommended with methotrexate to reduce adverse effects 1
• Folic acid should be taken daily except on the day methotrexate is administered 1, 3
• Consider taking meloxicam and methotrexate on different days of the week if possible 4
• Avoid high-dose aspirin with methotrexate, as this combination has shown more significant adverse effects than other NSAIDs 4
• Maintain adequate hydration to improve renal elimination of methotrexate 1

Warning Signs to Monitor

• Watch for signs of increased methotrexate toxicity: 5
  • Unexplained fatigue or malaise
  • Nausea, vomiting, or diarrhea
  • Mouth sores or ulcers
  • Unusual bruising or bleeding
  • Yellowing of skin or eyes
• If these symptoms occur, temporarily discontinue both medications and seek medical attention 5

Special Precautions

• Avoid this combination in patients with:
  • Pre-existing renal impairment 1, 5
  • Significant liver disease 5
  • Heavy alcohol consumption 5
• Dose adjustments may be necessary in elderly patients or those with mild renal impairment 1
• Consider alternative pain management strategies in high-risk patients 6

The 2014 study specifically examining meloxicam with methotrexate provides the most direct evidence regarding this combination, showing that even with higher-dose methotrexate (above 15mg weekly), the addition of meloxicam did not significantly increase the risk of kidney or liver damage in patients with normal baseline function 2. However, appropriate monitoring remains essential to ensure patient safety.