Acetylsalicylic acid × Meloxicam

Meloxicam and aspirin are both NSAIDs. Together they damage the stomach and gut lining more, and the risk of ulcers and bleeding rises through a synergistic effect (meloxicam and aspirin 100 mg SmPCs). In a clinical study cited in the US meloxicam label (FDA), an NSAID plus aspirin caused significantly more gastrointestinal adverse reactions than the NSAID alone. Aspirin also inhibits platelet aggregation for several days after a dose (aspirin 100 mg SmPC).

Gum bleeding, epistaxis, bruising without trauma, black or tarry stools. Severe cases: GI bleeding.

The meloxicam SmPC does not recommend combining it with aspirin at 500 mg or more per dose or 3 g or more a day, and the aspirin 100 mg SmPC advises avoiding NSAIDs with aspirin whenever possible (meloxicam and aspirin 100 mg SmPCs). The FDA does not generally recommend meloxicam with either low-dose or analgesic-dose aspirin because of bleeding risk, and notes that meloxicam is not a substitute for low-dose aspirin for cardiovascular protection (US meloxicam label). If meloxicam is still needed with low-dose aspirin, consider gastroprotection with misoprostol or a proton pump inhibitor (meloxicam SmPC). Warn the patient in advance about signs of bleeding: black stools, vomiting blood, abdominal pain, weakness, dizziness, cold sweat. If they appear, the patient stops the medicines and seeks medical care at once (aspirin 100 mg SmPC).