Major
Acetylsalicylic acid × Escitalopram
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Escitalopram (SSRI) depletes the platelet serotonin pool, impairing primary haemostasis. Aspirin irreversibly blocks platelet cyclooxygenase. Combined, GI bleeding risk roughly doubles.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, black tarry stools, blood in urine. Severe cases include gastrointestinal or intracranial haemorrhage.
Management
The combination is acceptable at low aspirin doses (75–100 mg as cardioprotection). Mandatory PPI cover with pantoprazole. Alternative antidepressants with minimal platelet effect: mirtazapine or agomelatine.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.