Moderate
Acetylsalicylic acid × meloxicam
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×NSAID, COX-2 preferential, oxicam derivative
Mechanism
Meloxicam is preferentially COX-2 selective and weakly displaces aspirin from COX-1. Additive GI bleeding risk persists from the ulcerogenic effect of both drugs.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, black or tarry stools. Severe cases: GI bleeding.
Management
Aspirin's cardioprotective effect is preserved better than with ibuprofen/naproxen. PPI cover with pantoprazole is mandatory in chronic meloxicam therapy. Alternative analgesic: paracetamol or celecoxib.