Major
meloxicam × Rivaroxaban
NSAID, COX-2 preferential, oxicam derivative×Direct oral anticoagulants (factor Xa inhibitors)
Mechanism
Direct oral anticoagulant (rivaroxaban) + NSAID (meloxicam) – additive GI bleeding risk via combined anticoagulation, mucosal injury, and platelet dysfunction.
Symptoms
Black or tarry stools, vomiting blood, epigastric pain. Risk multiplies in older patients and with prior peptic ulcer disease.
Management
Avoid prolonged combination. If meloxicam is needed for a short course, use the minimum effective dose for 5–7 days under pantoprazole cover. For chronic analgesia: paracetamol or celecoxib.