MajorNSAID, COX-2 preferential, oxicam derivative×Antimetabolites, folic acid analogues
Updated · Methodology
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.
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Sources
- FDA: Methotrexate Sodium Tablets prescribing information (2016)– ; DailyMed setid 8f1260de-b60c-4f0e-8af6-0e957b0a281b
- AEMPS: Ficha técnica: Meloxicam (nº registro 66400), sección 4.5 (2023)– AEMPS, CIMA, nº registro 66400, revisión 11/2023, sección 4.5