Is it safe to prescribe Celebrex (celecoxib) with meloxicam (Mobic)?

Celebrex (Celecoxib) and Meloxicam Should Not Be Prescribed Together

Concomitant use of celecoxib (Celebrex) with meloxicam (Mobic) is not recommended due to increased risk of gastrointestinal toxicity with little or no increase in efficacy. 1

Mechanism and Classification

• Both celecoxib and meloxicam are NSAIDs that work by inhibiting cyclooxygenase (COX) enzymes, though with different selectivity profiles 2
• Celecoxib is a selective COX-2 inhibitor, while meloxicam is less selective, partially inhibiting COX-1 at higher doses 3
• Using two NSAIDs simultaneously increases the risk of adverse effects without providing additional therapeutic benefit 1

FDA Warning Against NSAID Combinations

• The FDA drug label for celecoxib explicitly states: "The concomitant use of Celecoxib with other NSAIDs or salicylates is not recommended" 1
• This warning exists because combining NSAIDs increases gastrointestinal toxicity risk without meaningful efficacy improvements 1

Gastrointestinal Risks

• Both medications individually carry risks of serious gastrointestinal adverse events including inflammation, bleeding, ulceration, and perforation 2
• Combining these medications would compound these risks unnecessarily 1
• Elderly patients are at particularly high risk for serious gastrointestinal events when taking NSAIDs 2
• The risk of GI bleeding recurrence is as high as 5% in the first six months in persons with a history of upper GI tract bleeding taking NSAIDs 2

Cardiovascular Risks

• Both medications can increase cardiovascular risks including myocardial infarction, stroke, worsening hypertension, and heart failure 2
• Mean blood pressure increases by approximately 5 mm Hg with NSAID use 2
• Combining these medications could potentially increase these cardiovascular risks 2

Renal Risks

• All NSAIDs can cause volume-dependent renal failure, interstitial nephritis, and nephrotic syndrome 2
• Approximately 2% of persons stop taking NSAIDs due to renal complications 2
• Using multiple NSAIDs simultaneously increases the risk of renal adverse effects 2

Alternative Approaches

If additional pain control is needed beyond a single NSAID:

• Consider non-NSAID analgesics as adjuncts (e.g., acetaminophen) 2
• For patients requiring gastrointestinal protection while on a single NSAID, consider adding a proton pump inhibitor or misoprostol 2
• Choose either celecoxib OR meloxicam based on individual patient factors:
  • Celecoxib may have a lower risk of complicated upper GI conditions (44% relative reduction) compared to meloxicam 4
  • Meloxicam is generally less expensive (average savings of $183 per prescription compared to celecoxib) 3

Special Considerations

• Patients with history of GI bleeding should avoid NSAIDs altogether or use a single agent with gastroprotection 2
• Patients with cardiovascular risk factors should use NSAIDs with caution, as both medications carry cardiovascular risks 2
• Patients with renal disease, congestive heart failure, or cirrhosis should avoid NSAIDs when possible 2

Monitoring Recommendations

If a single NSAID must be used despite risks:

• Monitor for signs of GI bleeding or ulceration 2
• Monitor blood pressure regularly 2
• Consider periodic assessment of renal function, especially in high-risk patients 2