Symbravo Side Effects: What to Expect and When to Call Your Doctor

Symbravo (meloxicam 20 mg and rizatriptan 10 mg) is an FDA-approved medication for acute migraine — but like all prescription drugs, it comes with a range of potential side effects, from mild and manageable to rare but serious. Understanding what to expect helps you use Symbravo safely and know when something requires a call to your doctor or a trip to the emergency room.

Symbravo's Boxed Warning: The Most Serious Risks

Symbravo carries a Boxed Warning — the FDA's strongest safety label — for two categories of serious risk, both related to the meloxicam (NSAID) component:

Serious cardiovascular thrombotic events: NSAIDs can increase the risk of heart attack and stroke. This risk may occur early in treatment and may increase with longer use. Symbravo is contraindicated in patients with coronary artery disease, significant cardiovascular disease, or immediately after bypass (CABG) surgery.

Serious gastrointestinal adverse events: NSAIDs can cause bleeding, ulceration, and perforation of the stomach or intestines — sometimes without warning symptoms. Risk is higher in elderly patients and those taking corticosteroids, anticoagulants, SSRIs, or aspirin.

Common Side Effects of Symbravo

In clinical trials (MOMENTUM, INTERCEPT, MOVEMENT), the most commonly reported side effects with Symbravo (occurring in ≥1% of patients and more often than with placebo) were:

Dizziness — The most frequently reported side effect. Usually mild and transient. Avoid driving or operating heavy machinery if you experience significant dizziness.

Somnolence (drowsiness) — Also common. May contribute to driving impairment. Rest after taking Symbravo during a migraine attack if possible.

Additional side effects seen in clinical studies that included both the NSAID and triptan components:

Nausea and vomiting (also common migraine symptoms themselves)

Fatigue

Muscle tightness or pain

Chest, throat, neck, or jaw sensations (pressure, tightness, pain) — common with triptans; usually benign but requires evaluation if severe or associated with other symptoms

Serious Side Effects: When to Call Your Doctor or Call 911

Stop taking Symbravo and seek immediate medical attention if you experience:

Signs of heart attack or stroke: Chest pain, sudden severe headache, slurred speech, weakness or numbness in face, arm, or leg, sudden vision changes, difficulty breathing

GI bleeding: Blood in stool, black tarry stools, vomiting blood, or severe stomach pain

Serious allergic reaction: Hives, swelling of face/lips/tongue/throat, severe rash, difficulty breathing — seek emergency care immediately

Serious skin reactions: Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis — blistering, peeling skin, flu-like symptoms before rash development

Serotonin syndrome: Agitation, hallucinations, rapid heart rate, high fever, twitching muscles, nausea/vomiting/diarrhea — risk increased if taking SSRIs, SNRIs, or other serotonergic drugs

Signs of arrhythmia: Irregular heartbeat, palpitations, fainting

Kidney problems: Decreased urination, swelling in legs/feet/ankles, unexplained weight gain (fluid retention)

Special Populations: Additional Risks to Know

Certain groups face elevated risk from specific Symbravo components:

Pregnancy: NSAIDs should be avoided after 20 weeks of pregnancy due to risk of fetal kidney problems (oligohydramnios). Avoid after 30 weeks entirely. Discuss with your OB before taking Symbravo.

Fertility: NSAIDs are associated with reversible impairment of female fertility. Consider stopping Symbravo in women having difficulty conceiving.

Aspirin-sensitive asthma: Contraindicated in patients with history of asthma attacks, urticaria, or other reactions to aspirin or NSAIDs.

Medication Overuse Headache: A Lesser-Known Risk

Like all acute migraine medications, Symbravo can cause medication overuse headache (MOH) if used too frequently. MOH occurs when patients take acute migraine treatments on 10 or more days per month, which can paradoxically worsen headache patterns over time. The Symbravo label includes a warning for MOH, and detoxification may be necessary if this develops. Monitor your usage and discuss with your doctor if you're using Symbravo more than twice a week.

Tips to Minimize Side Effects

Take with food if GI upset occurs (though a high-fat meal significantly delays absorption)

Avoid alcohol after taking Symbravo — it can worsen GI risk and increase dizziness

Do not take more than one tablet per day

Do not take other NSAIDs or aspirin alongside Symbravo without consulting your doctor first

For a full guide on Symbravo drug interactions, see Symbravo Drug Interactions: What to Avoid and What to Tell Your Doctor.