Symbravo Drug Interactions: What to Avoid and What to Tell Your Doctor

Symbravo (meloxicam and rizatriptan) contains two active ingredients — an NSAID and a triptan — each with its own set of drug interactions. Before taking Symbravo, it's essential that your doctor and pharmacist have a complete list of everything you're taking: prescription drugs, OTC medications, vitamins, and supplements. Here's a plain-English guide to Symbravo's most important interactions.

Contraindicated Combinations: Never Take With Symbravo

These combinations are contraindicated — meaning you should NOT take Symbravo at all if you're using these medications:

1. MAO-A Inhibitors

Do NOT take Symbravo if you are currently taking or have taken a MAO-A inhibitor within the past 14 days. MAO-A inhibitors include:

Phenelzine (Nardil)

Tranylcypromine (Parnate)

Isocarboxazid (Marplan)

Why: MAO inhibitors slow the breakdown of rizatriptan in the body, causing rizatriptan plasma levels to increase dramatically — potentially leading to dangerous cardiovascular effects and serotonin toxicity. A 14-day washout period is required between stopping an MAO inhibitor and starting Symbravo.

2. Other Triptans (Within 24 Hours)

Do not take Symbravo within 24 hours of using any other triptan medication, including sumatriptan, eletriptan, zolmitriptan, naratriptan, almotriptan, or frovatriptan. Combining two triptans increases the risk of cardiovascular adverse effects and excessive vasoconstriction.

3. Ergotamine Medications (Within 24 Hours)

Do not take Symbravo within 24 hours of ergotamine-containing medications or ergot-type drugs, including dihydroergotamine (DHE, Migranal) and methysergide. These combinations can cause dangerous vasoconstriction and cardiovascular events.

Major Interactions: Use With Caution (Tell Your Doctor)

Anticoagulants (Blood Thinners)

NSAIDs like meloxicam impair platelet aggregation and can increase bleeding risk. Taking Symbravo with anticoagulants significantly raises the risk of serious GI or other bleeding events. Affected medications include:

Warfarin (Coumadin) — INR monitoring is strongly recommended

Direct oral anticoagulants (apixaban/Eliquis, rivaroxaban/Xarelto, dabigatran/Pradaxa)

Heparin

Aspirin

Concomitant use of Symbravo with analgesic doses of aspirin is not generally recommended — it increases GI bleeding risk without added cardiovascular benefit. Low-dose (81 mg) cardioprotective aspirin may still be used in appropriate patients, but discuss with your doctor. Symbravo already contains an NSAID (meloxicam), so adding aspirin creates additive NSAID-type risk.

SSRIs and SNRIs (Antidepressants)

Two separate concerns:

Increased bleeding risk: SSRIs and SNRIs impair platelet function; combined with Symbravo's NSAID component, bleeding risk increases

Serotonin syndrome risk: Combining rizatriptan (a serotonergic drug) with SSRIs/SNRIs can — rarely — increase risk of serotonin syndrome (agitation, high fever, rapid heart rate, muscle twitching). Monitor for symptoms.

Common SSRIs: fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil). Common SNRIs: venlafaxine (Effexor), duloxetine (Cymbalta).

Blood Pressure Medications (ACE Inhibitors, ARBs, Beta-Blockers, Diuretics)

The meloxicam component of Symbravo can reduce the effectiveness of antihypertensive medications:

ACE inhibitors and ARBs: NSAIDs may blunt their blood pressure-lowering effect. Combined use also increases risk of acute kidney injury, especially in dehydrated patients or those with pre-existing kidney disease.

Diuretics: NSAIDs reduce diuretic effectiveness and can cause sodium retention; increased renal monitoring may be needed

Propranolol (a beta-blocker): Specifically, propranolol significantly increases rizatriptan exposure (blood levels). Patients taking propranolol should use the lower 5 mg rizatriptan dose — but because Symbravo contains a fixed 10 mg dose, patients on propranolol may need to discuss with their doctor whether Symbravo is appropriate.

Lithium

NSAIDs can increase serum lithium levels by reducing renal clearance of lithium. If you take lithium for bipolar disorder or other conditions, tell your doctor before taking Symbravo — lithium blood levels should be monitored closely.

Corticosteroids

Combining NSAIDs with corticosteroids (prednisone, methylprednisolone, etc.) significantly increases the risk of GI bleeding and ulceration. If you take steroids regularly, discuss whether Symbravo is appropriate given your GI risk.

Tell Your Doctor and Pharmacist Everything

Before your first Symbravo prescription, give your provider a complete medication list including OTC pain relievers, supplements (especially fish oil, vitamin E, and ginkgo — which also affect platelet function), herbal products, and any new prescriptions. Pharmacies can also run drug interaction checks using their system — ask your pharmacist to review your full medication profile when picking up Symbravo.

Also read Symbravo Side Effects: What to Expect and When to Call Your Doctor for a full picture of potential adverse reactions.