From the Guidelines
It is not recommended to take meloxicam with Brilinta (ticagrelor) without medical supervision due to the potential increased bleeding risk. When considering the use of meloxicam, a nonsteroidal anti-inflammatory drug (NSAID), with Brilinta (ticagrelor), an antiplatelet medication, it's crucial to weigh the risks and benefits, particularly the risk of bleeding complications, including gastrointestinal bleeding 1. The European Society of Cardiology working group on cardiovascular pharmacotherapy emphasizes the importance of careful consideration when prescribing medications like antiplatelets and NSAIDs together, especially in older adults with cardiovascular disease 1. Given the potential for an additive effect on blood thinning, patients taking Brilinta should consult their healthcare provider before using any NSAID, including meloxicam 1. Alternative pain relief options such as acetaminophen (Tylenol) may be recommended as they do not affect platelet function, or if an NSAID is necessary, the lowest effective dose for the shortest duration possible may be prescribed, along with additional protective medications to mitigate bleeding risk 1. Ultimately, the decision to use meloxicam with Brilinta should be made under medical supervision, taking into account the individual patient's risk factors for bleeding and the potential benefits of the combination therapy 1.
From the Research
Interaction between Meloxicam and Brilinta
- There is no direct evidence of an interaction between meloxicam and Brilinta (ticagrelor) in the provided studies.
- However, it is known that both meloxicam, a nonsteroidal anti-inflammatory drug (NSAID), and Brilinta, an antiplatelet drug, can increase the risk of bleeding 2, 3.
- A study on meloxicam found that it does not significantly interfere with platelet-mediated hemostasis, as measured by bleeding time and aggregometry, even at supratherapeutic doses 4.
- Another study found that the risk of upper gastrointestinal bleeding is substantially decreased by the concomitant use of proton pump inhibitors with antiplatelet drugs, including ticagrelor 2.
- The use of meloxicam with Brilinta may require careful consideration of the potential increased risk of bleeding, and the use of proton pump inhibitors may be necessary to mitigate this risk 2, 3.
Bleeding Risk with Antiplatelet Drugs
- The risk of upper gastrointestinal bleeding associated with antiplatelet drugs, including ticagrelor, is a concern 2, 3.
- A study found that the individual risks of upper gastrointestinal bleeding for antiplatelet drugs were: cardiovascular acetylsalicylic acid 4.0, clopidogrel 2.3, and ticlopidine 3.1 2.
- The concomitant use of proton pump inhibitors can decrease the risk of upper gastrointestinal bleeding associated with antiplatelet drugs 2.
Meloxicam and Platelet Function
- Meloxicam is a selective inhibitor of cyclooxygenase-2 (COX-2) and has a relatively low risk of interfering with platelet function compared to nonselective NSAIDs 5, 4.
- A study found that meloxicam did not cause a significant increase in bleeding time or inhibition of platelet aggregation to any agonist when compared with placebo 4.