Acetylsalicylic acid × Duloxetine

Duloxetine inhibits the reuptake of serotonin and noradrenaline. Platelets release serotonin when they stop bleeding, so such antidepressants raise the risk of bleeding, including from the upper gastrointestinal tract. Aspirin irreversibly blocks platelet cyclooxygenase and injures the stomach lining. According to the US Food and Drug Administration (FDA) duloxetine label, aspirin may add to the bleeding risk during duloxetine treatment.

Gum bleeding, epistaxis, bruising without trauma, black or tarry stools. Severe cases: GI bleeding.

The combination can be used with caution: the Spanish and EU duloxetine SmPCs ask for caution in patients taking drugs that affect platelet function and name aspirin. The US Food and Drug Administration (FDA) requires prescribers to warn patients about the higher bleeding risk when duloxetine is combined with aspirin (duloxetine FDA label). Explain the signs of bleeding to the patient in advance: bruising without injury, nosebleeds, black stools, vomiting blood. With black stools, vomiting blood or any other sign of gastric bleeding, the patient stops aspirin and sees a doctor at once (aspirin 100 mg SmPC).