Itraconazole × Meloxicam

The liver breaks down meloxicam mainly through the enzyme CYP2C9, with a smaller contribution from the enzyme CYP3A4. Itraconazole strongly inhibits CYP3A4, yet it lowers meloxicam levels. In a study with meloxicam 15 mg, peak concentration fell by 64% and the area under the curve by 37%. The labels do not explain why. The risk of the combination is that meloxicam may work less well.

Meloxicam may relieve pain and inflammation less well. In osteoarthritis flares, rheumatoid arthritis or ankylosing spondylitis, pain and stiffness in the joints or spine return or get worse. Meloxicam levels fall with this pair, so the labels describe no meloxicam overdose from it.

Use meloxicam cautiously alongside itraconazole. Check whether its effect has weakened and adjust the dose if needed (itraconazole label, Spanish Agency of Medicines and Medical Devices, AEMPS). A higher meloxicam dose may be necessary (itraconazole label, US Food and Drug Administration, FDA). The meloxicam dose limit stays the same: no more than 15 mg a day, and no more than 7.5 mg a day in patients on dialysis with severe kidney failure (meloxicam label, AEMPS). Give meloxicam at the lowest effective dose for the shortest time, and regularly review whether it is still needed and how well it works (meloxicam label, AEMPS). If the meloxicam dose was raised during the itraconazole course, review it in the same way after itraconazole is stopped. Itraconazole takes 7–14 days to leave the blood (itraconazole label, AEMPS).