Moderate
Bisoprolol × meloxicam
Selective beta-adrenergic blockers×NSAID, COX-2 preferential, oxicam derivative
Mechanism
NSAIDs weaken the antihypertensive effect of beta-blockers. Meloxicam is less ulcerogenic than non-selective NSAIDs (preferential COX-2 activity), but the renal effect persists.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
For short meloxicam courses (5–7 days), monitor blood pressure. For chronic analgesia: switch to paracetamol or celecoxib (with PPI cover).