Meloxicam Does Not Affect the Antiplatelet Effect of Aspirin in Healthy Male and Female Volunteers

Abstract

This study determined if meloxicam, a selective cyclooxygenase (COX)-2 inhibitor, interferes with the antiplatelet effect of aspirin using platelet aggregation and thromboxane (Tx) B(2) endpoints in healthy volunteers. Eight male and 8 female volunteers participated in this open-label, randomized, two-treatment, two-way crossover trial. Treatment 1 was meloxicam (15 mg qd) over 4 days, and then aspirin (100 mg qd) was ingested 2 hours after meloxicam for an additional 7 days. Blood samples were taken 2, 6, and 24 hours after the last dose. Treatment 2 consisted of only aspirin (100 mg) over 2 days. Samples were taken at the same time points. Each subject received both treatments with a 2-week washout between the treatment periods. Treatments were safe and well tolerated. The initial 4-day treatment with meloxicam had no effect on platelet aggregation but reduced serum TxB(2) by 64% +/- 19%. Addition of aspirin (100 mg qd) for 7 days resulted in complete inhibition of aggregation and TxB(2) for 24 hours. Two-day treatment with only 100 mg aspirin also resulted in complete inhibition of platelet aggregation and TxB(2). These results indicate that meloxicam does not affect the ability of aspirin to inhibit COX-1 in platelets, thereby allowing aspirin to effectively prevent platelet aggregation and reduce TxB(2) levels, and that meloxicam is selective for COX-2.

The effect of COX-2-selective meloxicam on the myocardial, vascular and renal risks: a systematic review

“…This, however, appears not to be an across the class effect since by replacing ASA from its receptors on platelet, some NSAIDs (e.g., ibupropfen, indomethacin, naproxen and tiaprofenic acid) abolish the cardioprotective properties of the drug. Such an interaction does not take place for meloxicam (Van Ryn et al 2004), sulindac and celecoxib (Gladding et al 2008). The concomitant use of ASA has a negligible effect on the already small increased risk of meloxicam use (Table 4).…”

The prognostic utility of tests of platelet function for the detection of ‘aspirin resistance’ in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation

“…A well-described interaction between aspirin and NSAIDs such as ibuprofen and naproxen [but not rofecoxib (Vioxx ® , Merck Sharpe & Dohme), celecoxib (Celebrex ® , Pfizer), meloxicam, acetaminophen or diclofenac] has been shown to have an impact on platelet aggregation responses. [51][52][53][54] These drugs prevent aspirin from binding to its target, platelet COX-1. Therefore, current guidelines recommend that concomitant use of NSAIDs with aspirin should be carefully avoided.…”

Prospects for using injectable meloxicam (Amelotex®) in patients with osteoarthrosis

“…Известно, что некоторые НПВП блокируют кардиопротективное действие аспирина, снижая его способность к длительному ингибированию тром-боксанзависимой агрегации тромбоцитов. Прием мелоксика-ма, напротив, не оказывает существенного влияния на эффек-ты аспирина в отношении ингибирующего действия на агрега-цию тромбоцитов и сывороточный уровень тромбоксана В2 (TxB2) [14]. Так, данные проспективного исследования больных ОА и ревматоидным артритом (РА) продемонстрировали, что относительный риск (ОР) развития инфаркта миокарда при со-вместном приеме аспирина и мелоксикама составил 0,53 (0,26-1,10), что оказалось намного ниже, чем при параллель-ном приеме аспирина с другими, особенно неселективными, НПВП [15].…”