Acetylsalicylic acid × Fluvoxamine

Fluvoxamine, like other selective serotonin reuptake inhibitors (SSRIs), blocks serotonin uptake into platelets, and platelets need serotonin to stop bleeding. Aspirin irreversibly blocks platelet cyclooxygenase and injures the stomach lining. Together they raise the risk of bleeding, above all from the upper gastrointestinal tract (aspirin and fluvoxamine labels).

Gum bleeding, epistaxis, bruising without trauma. Severe cases: GI bleeding.

Aspirin SmPCs, including those for 100 mg products, advise avoiding selective serotonin reuptake inhibitors (SSRIs) with aspirin whenever possible because of the bleeding risk, especially from the upper gastrointestinal tract (aspirin 100 mg SmPCs). If the combination is needed, use it with caution, particularly in older people (fluvoxamine SmPC), and explain the signs of bleeding to the patient in advance: black stools, vomiting blood, low blood pressure, cold sweat, abdominal pain, dizziness. If they appear, the patient stops treatment and sees a doctor at once (aspirin 100 mg SmPC). The US Food and Drug Administration (FDA) also requires prescribers to warn patients about the higher bleeding risk when fluvoxamine is combined with aspirin (fluvoxamine FDA label).