Meloxicam with Voriconazole Interaction Details
Brand Names Associated with Meloxicam
- Meloxicam
- Mobic®
Brand Names Associated with Voriconazole
- Vfend®
- Voriconazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
Increased meloxicam plasma concentrations
Interaction Summary
In an open-labeled, randomized, three-phase crossover study of 12 males, coadministration of meloxicam (a CYP2C9 substrate) and voriconazole resulted in a 47% increase in mean meloxicam AUC (0 to 72 hours) and a 51% increase in the mean meloxicam half-life. Increased plasma concentrations of meloxicam may result in increased adverse effects such as edema, dizziness, rash or gastrointestinal distress. Frequent monitoring for NSAID toxicities is recommended during coadministration and dosage reduction of meloxicam may be necessary .
Severity
Moderate
Onset
Delayed
Evidence
Established
How To Manage Interaction
Coadministration of meloxicam and voriconazole may lead to increased meloxicam plasma levels and potentially increased adverse effects such as edema, dizziness, rash or gastrointestinal distress. Close monitoring for NSAID-related adverse events is recommended and dosage reduction of meloxicam may be warranted .
Mechanism Of Interaction
Inhibition of CYP2C9-mediated meloxicam metabolism
Literature Reports
A) An open-labeled, randomized, three-phase crossover study of 12 males (ages 19 to 39 years) experienced an increase in meloxicam plasma concentrations when given concomitantly with voriconazole. The subjects were given either no pretreatment (control), pretreatment with voriconazole (400 mg every 12 hours on day 1 and 200 mg every 12 hour on day 2) or pretreatment with itraconazole (200 mg/day in the morning for 4 days) in random order with a 4 week washout period between phases. One hour following the last dose of either voriconazole or itraconazole, meloxicam 15 mg was administered. Coadministration with voriconazole resulted in an increase in the mean meloxicam AUC (0 to 72 hours) of 47% (p less than 0.001) compared with control. The mean half-life of meloxicam also increased 51% from 17.4 to 26.7 hours. The mean Cmax and median Tmax of meloxicam were not affected by voriconazole. No differences in thromboxane B2 inhibition were seen at any measurement point between the voriconazole and the control phases.
Meloxicam Overview
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Meloxicam is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints) and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints). Meloxicam is also used to relieve the pain, tenderness, swelling, and stiffness caused by juvenile rheumatoid arthritis (a type of arthritis that affects children) in children 2 years of age and older. Meloxicam is in a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). It works by stopping the body's production of a substance that causes pain, fever, and inflammation.
Voriconazole Overview
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Voriconazole is used in adults and children 2 years of age and older to treat serious fungal infections such as invasive aspergillosis (a fungal infection that begins in the lungs and spreads through the bloodstream to other organs), esophageal candidiasis (a yeast [a type of fungus] infection that may cause white patching in the mouth and throat), and candidemia (a fungal infection in the blood). It is also used to treat certain other fungal infections when other medications will not work for certain patients. Voriconazole is in a class of antifungal medications called triazoles. It works by slowing the growth of the fungi that cause infection.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.