sertraline and aspirin

Sertraline, a selective serotonin reuptake inhibitor, prevents serotonin reuptake into platelets, reducing platelet serotonin content and impairing platelet aggregation. Aspirin irreversibly inhibits cyclooxygenase-1, decreasing thromboxane A2 synthesis, which is a potent platelet aggregator. The combined pharmacodynamic effect is additive inhibition of platelet function, increasing bleeding risk.

Patients taking both drugs have an increased risk of bleeding, particularly gastrointestinal bleeding. The risk is higher with concurrent use of other ulcerogenic drugs or in patients with a history of bleeding disorders. Although the interaction is not always clinically significant, it can lead to serious complications such as haematemesis or melaena.

Use with caution. Monitor patients for signs of bleeding, such as anaemia, black stools, or epistaxis. Consider gastroprotective therapy, such as a proton pump inhibitor, especially in patients with risk factors. Weigh the benefits of antiplatelet therapy against the risk of bleeding. If excessive bleeding occurs, review the need for sertraline and consider alternatives.

Well established from pharmacodynamic studies and large epidemiological cohorts showing an increased risk of upper gastrointestinal bleeding in patients taking SSRIs with antiplatelet agents.