sertraline and ibuprofen

Sertraline, a selective serotonin reuptake inhibitor, reduces platelet serotonin content, impairing platelet aggregation. Ibuprofen, a non-steroidal anti-inflammatory drug, inhibits cyclooxygenase-1, decreasing gastric mucosal prostaglandin synthesis and increasing gastrointestinal mucosal vulnerability. The combined effect is an additive increase in bleeding risk.

Co-prescription significantly increases the risk of gastrointestinal bleeding, which can be severe in susceptible patients. Risk is highest in the elderly, those with a history of peptic ulcer disease, and those taking other agents that increase bleeding risk. Bleeding may also occur at other sites such as intracranial or nasal.

Avoid concomitant use unless clearly necessary. If the combination is required, consider adding a proton pump inhibitor for gastroprotection, use the lowest effective dose of ibuprofen for the shortest duration, and monitor patients for signs of gastrointestinal bleeding, such as melaena or haemorrhage. Advise patients to report any black stools or unexplained abdominal pain.

Extensively documented in observational studies and meta-analyses. The interaction is widely recognised and included in formularies and drug interaction databases.