MajorAntiplatelet agents (low dose) / NSAIDs (analgesic dose)×Selective serotonin reuptake inhibitors (SSRIs)
Updated · Methodology
Mechanism
Sertraline (SSRI) depletes the platelet serotonin pool, weakening platelet aggregation. Aspirin irreversibly blocks platelet cyclooxygenase. Combined, GI bleeding risk roughly doubles.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, black 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). PPI cover with pantoprazole is mandatory. 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.
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Sources
- PubMed: SSRIs increase bleeding risk when combined with antiplatelets and anticoagulants (2019)
- AEMPS: Ficha técnica: Sertralina (nº registro 66057), sección 4.4 (2025)– AEMPS, CIMA, nº registro 66057, revisión 08/2025, sección 4.4