Major
Sertraline × Warfarin
Selective serotonin reuptake inhibitors (SSRIs)×Vitamin K antagonist anticoagulants
Mechanism
Sertraline (SSRI) blocks serotonin reuptake into platelets, depleting the platelet serotonin pool and impairing primary haemostasis. Even with a stable INR, GI bleeding risk roughly doubles in warfarin-treated patients.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.
Management
The combination is acceptable. PPI cover with pantoprazole and more frequent INR checks (every 2–4 weeks in the first month) are advisable. 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.
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