Fort Worth, TX—When pharmacists dispense prescriptions for selective serotonin reuptake inhibitors (SSRIs), they might want to add a caution and a reminder about increased bleeding risks.

A research review in the Journal of the American Osteopathic Association advises that patients on SSRIs are 40% more likely to develop severe gastrointestinal bleeding, especially if they also are taking nonsteroidal anti-inflammatory drugs (NSAIDs) or some other medication classes.

The study points out that almost 13% of Americans age 12 years and older use an antidepressant, with SSRIs, by far, being the most common prescription. Those drugs can increase gastric-acid secretion and inhibit serotonin entrance into platelets, according to the report.

The review found troubling interactions with NSAIDs such as ibuprofen and naproxen, as well as anticoagulants such as warfarin or antiplatelet medications such as aspirin and clopidogrel.

“The real risk comes from the assumption that each of these drugs is relatively safe and benign. But they all carry a risk for bleeding, and that risk increases when these medications are taken concurrently,” explained lead author Wei Cheng Yuet, PharmD, assistant professor of pharmacotherapy at University of North Texas Health Science Center.

The study notes that gastrointestinal bleeding is most common, but, in some cases, patients have developed life-threatening intracranial bleeding.

The authors write that some studies have suggested proton-pump inhibitors to mitigate risks for patients taking SSRIs and concomitant medications, adding, “However, more evidence is needed in this area. Regarding the risk of intracranial bleeding, prudent monitoring is highly recommended for patients taking anticoagulants or antiplatelets with or without SSRI use.”

Yuet pointed out that the risk for bleeding with SSRIs is well established—drug labels include the information—but not well known among patients, adding, “Whenever physicians discover their patients are taking any combination of these medications, they should begin assessing the risks and benefits and determine whether there are alternative treatment plans,” says Yuet. “For example, physicians should periodically assess antidepressant use even when patients are stable on therapy.”

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