Meloxicam and Dalteparin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Meloxicam
Dalteparin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
An increased risk of bleeding
Interaction Deep Dive
Concomitant use of low-molecular-weight heparins (LMWH) or heparinoids with NSAIDs may increase the risk of major bleeding events, including epidural or spinal hematomas in patients who are receiving neuraxial anesthesia or undergoing spinal puncture. Discontinuation of an NSAID prior to initiation of LMWH therapy is recommended when possible2. If concomitant use of an LMWH and an NSAID is required, use extreme caution and closely monitor the patient for signs and symptoms of bleeding 1.
Why it happens (mechanism)
Decreased platelet function; decreased coagulation
Literature reports
4 reports — tap to read
a) A 60-year-old female patient taking aspirin, naproxen, nifedipine, captopril, cimetidine, and potassium supplements was scheduled for ambulatory arthroscopic lateral meniscectomy. Ninety minutes prior to the initiation of epidural anesthesia, she received 30 mg of a low-molecular-weight heparin. The surgical procedure was uneventful, and she was discharged home with full motor and sensory function. Approximately 2 hours later, she began to experience excruciating lumbar back pain and returned to the hospital 90 minutes later. By this time, she had lost motor function of her lower extremities. Computerized tomography revealed an epidural hematoma, which was subsequently removed during emergency surgery. The patient regained full motor and sensory function by the second postoperative day. Although aspirin, NSAIDs, and low-molecular-weight heparin are all considered safe when administered alone prior to neuraxial block, it was felt that the combination of all 3 agents in this patient resulted in the development of the epidural hematoma 3.
b) Sixty patients undergoing total hip replacement surgery were randomized into 2 groups to determine whether enoxaparin and ketorolac used simultaneously can result in excessive postoperative bleeding. Prior NSAID therapy was discontinued 4 weeks before surgery. All patients received enoxaparin 40 mg subcutaneously 12 hours prior to surgery and then once daily for 10 days. Twenty-six patients also received ketorolac 30 mg intramuscularly on induction of anesthesia and then 30 mg once daily for 4 days. The other 34 patients received enoxaparin and opioid and acetaminophen analgesia. There were no significant differences between groups for intraoperative blood loss, postoperative drainage, transfusion requirements, wound oozing, bruising, and leg swelling. Also, no patients developed a clinically detectable gastrointestinal hemorrhage. The authors suggested that the risk of increased bleeding due to concomitant administration of a low-molecular-weight heparin and an NSAID is low, provided that the dose of the NSAID is modest 4.
c) A retrospective study of patients given enoxaparin in hip replacement surgery found significantly higher perioperative blood loss and increased use of blood transfusions in the group of patients who used preoperative NSAIDs compared with the group who did not use NSAIDs prior to surgery. No difference was found in the 2 groups comparing postoperative blood loss 5.
d) Twenty-four healthy male volunteers between the ages of 18 and 55 years were given all 4 combinations of ketorolac/placebo and dalteparin/placebo in a double-blind, placebo-controlled, randomized, crossover study designed to assess the hemostatic interaction between ketorolac and dalteparin. Ketorolac inhibited platelet aggregation in both whole blood and platelet-rich plasma and consequently prolonged the skin bleeding time. Although in range with normal population, there was a significant increase in levels of antifactor Xa and prolongation in the activated partial thromboplastin time after dalteparin administration. There was an interaction between ketorolac and dalteparin to prolong bleeding time, but dalteparin alone had no effect on bleeding time. There exists the possibility of hemorrhagic complications developing perioperatively when dalteparin and ketorolac are administered together 6.
Common questions
Can I take Meloxicam and Dalteparin together?
An increased risk of bleeding Always confirm with your pharmacist or prescriber before making any change.
How serious is the Meloxicam and Dalteparin interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Meloxicam or Dalteparin need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (6)
- Product Information: SPRIX(TM) nasal spray, ketorolac tromethamine nasal spray. Roxro Pharma, Inc, Menlo Park, CA, 2009. DailyMed
- Product Information: Lovenox(R) subcutaneous injection, intravenous injection, enoxaparin sodium subcutaneous injection, intravenous injection. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013. DailyMed
- Porterfield WR & Wu CL: Epidural hematoma in an ambulatory surgical patient. J Clin Anesth 1997; 9:74-76. PubMed
- Weale AE, Warwick DJ, Durant N, et al: Is there a clinical interaction between low molecular weight heparin and non-steroidal analgesics after total hip replacement?. Ann R Coll Surg Engl 1995; 77:35-37.
- Fauno P, Petersen KD, & Husted SE: Increased blood loss after preoperative NSAID. Acta Orthop Scand 1993; 64:522-524.
- Greer IA, Gibson JL, Young A, et al: Effect of ketorolac and low-molecular-weight heparin individually and in combination on haemostasis. Blood Coagul Fibrinolysis 1999; 10:367-373. PubMed
Keep reading about Meloxicam
Keep reading about Dalteparin
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