ModerateDirect oral anticoagulants (factor Xa inhibitors)×SSRI
Updated · Methodology
Mechanism
Fluvoxamine impairs primary haemostasis by inhibiting platelet serotonin reuptake. Additively with the direct factor Xa inhibitor apixaban, GI bleeding risk rises by 30–50%.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, black or tarry stools, haematuria. Higher risk in older patients, prior peptic ulcer disease, and chronic kidney disease.
Management
The combination is acceptable for short courses. If long-term SSRI is needed, in patients over 65 or with prior peptic ulcer add gastroprotection (pantoprazole 20 mg/day). Antidepressant alternatives without platelet effect: mirtazapine, agomelatine, trazodone.
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Eliquis (apixaban) prescribing information (2014)– ; DailyMed setid e9481622-7cc6-418a-acb6-c5450daae9b0
- AEMPS: Ficha técnica de Eliquis 5 mg comprimidos recubiertos con película (apixabán) (2026)– AEMPS, CIMA (texto EMA), nº registro 111691009, secciones 4.4 y 4.5