Major
meloxicam × Methotrexate
NSAID, COX-2 preferential, oxicam derivative×Antimetabolites, folic acid analogues
Mechanism
NSAIDs reduce renal methotrexate clearance. At high oncologic doses: myelosuppression and mucositis. At low rheumatologic doses, risk is smaller but monitoring is needed.
Symptoms
Stomatitis, diarrhoea, falling leukocyte, platelet, and erythrocyte counts. Severe cases: fatal pancytopenia, nephrotoxicity.
Management
At oncologic methotrexate doses, the combination is not prescribed. At low rheumatologic doses, meloxicam is acceptable for a short course with blood count and creatinine monitoring every 1–3 months.