Moderate
Clopidogrel × Sertraline
Antiplatelet agents – P2Y12 receptor inhibitors×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Clopidogrel blocks platelet aggregation via the P2Y12 receptor; sertraline impairs primary haemostasis by inhibiting platelet serotonin reuptake. Additive bleeding risk, mainly gastrointestinal.
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. In patients over 65 or with prior peptic ulcer disease, add gastroprotection — pantoprazole or esomeprazole 20 mg/day (avoid omeprazole — it suppresses clopidogrel activation). Antidepressant alternative without 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.
Sources
- Lexicomp: Lexicomp Drug Interactions (2024)– Wolters Kluwer Clinical Drug Information, Inc. Lexi-Interact Online, 2024
- Pharmaceutical Press: Stockley's Drug Interactions, 12th edition (2024)– Preston CL (ed.). Stockley's Drug Interactions. 12th ed. London: Pharmaceutical Press; 2024