Selective serotonin reuptake inhibitors increase risk of upper gastrointestinal bleeding when used with NSAIDs: a systemic review and meta-analysis

Abstract

The use of selective serotonin reuptake inhibitors (SSRIs) can increase the risk of gastrointestinal (GI) bleeding. Similarly, it is well known that the use of NSAIDs predisposes patients to upper GI bleeding. The aim of this study was to explore if the addition of SSRIs in patients already taking NSAIDs significantly increases their risk for upper GI bleeding. An electronic literature search was conducted using the SCOPUS and MEDLINE databases from inception through September 2020. Cohort and case–control trials that reported patients with upper GI bleeding on NSAIDs with SSRIs, compared to controls on NSAIDs only were included. Newcastle–Ottawa checklist was used to ensure inclusion of high-quality studies. Data was extracted by the lead investigator and cross-checked by the second author. Dichotomous data was pooled to obtain an odds ratio (OR) of the risk of upper GI bleeding in patients on NSAIDs with concomitant SSRI use. The primary endpoint of the study was the risk of upper GI bleeding with SSRIs and NSAIDs compared to NSAIDs alone. A total of 366 citations were reviewed, and 21 were selected for full-text evaluation. 1 cohort and 9 case–control studies were eligible. There was an additional increased risk of upper GI bleeding in patients on NSAIDs with concomitant SSRI use (OR 1.75, 95% CI = 1.32–2.33). In patients already on NSAID therapy, the concomitant use of SSRIs can significantly increase the risk of upper of GI bleeding.

Deprescribing of antidepressants: development of indicators of high-risk and overprescribing using the RAND/UCLA Appropriateness Method

“…First, the indicator set developed here is likely to identify more patients at risk of bleeding. For example, in contrast to the STOPP criteria, our set also considers the bleeding risk associated with SNRIs [ 40 , 41 ] as well as co-prescription with nonsteroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelets [ 40 , 42 ]. Second, in contrast to STOPP Fall, our expert panel did not confirm a higher fall risk for tricyclic antidepressants than other antidepressants [ 43 ], and our set identifies additional patients at risk for falls, such as those with cognitive impairment or dementia.…”

Judicious uses of NSAIDs in patients with COVID-19, dengue, and chikungunya

“…However, physicians should recognize that concurrent use of selective serotonin reuptake inhibitors (SSRIs) and NSAIDs was related to a 75% increased risk of upper GI bleeding and should advise patients appropriately if they choose to utilize SSRIs for the same. [9] is is particularly concerning because NSAIDs are frequently taken daily or sometimes many times per day, and SSRIs are typically prescribed for daily usage. Mindfulness-based therapies for insomnia management are recommended for both of these types of patients.…”

Das Blutungsrisiko unter Antidepressiva verstehen und einschätzen

“…Hierin zeigte sich ein signifikant erhöhtes Blutungsrisiko um das 1,75fache (95 % KI 1,32-2,33) unter Anwendern von SSRI und NSAR versus denjenigen, die nur ein NSAR einnahmen [51]. Dass insbesondere das Risiko für GI-Blutungen unter dieser Kombination erhöht ist, ist insofern nicht verwunderlich, da zudem die Synthese magenschleimhautschützender Prostaglandine durch NSAR gehemmt wird [51]. Auch hier kann die Anwendung von magensaftsekretionshemmenden Arzneistoffen wie PPI das Blutungsrisiko normalisieren [52].…”