Related Experiment Videos
Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and
Y K Loke1, A N Trivedi, S Singh
1School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. y.loke@uea.ac.uk
Background:
Selective serotonin reuptake inhibitors (SSRIs) have been associated with upper gastrointestinal haemorrhage (UGIH) but the magnitude and characteristics of this reaction and possible interaction with concurrent Non-Steroidal Anti-Inflammatory Drug (NSAID) therapy are unknown.
Aim:
To evaluate systematically the risk of UGIH with SSRIs, including interaction with NSAIDs.
Methods:
We searched PubMED, Science Citation Index, and trial registries for data on SSRIs, NSAIDs and UGIH. We evaluated spontaneous case reports from pharmacovigilance databases.
Results:
Random effects meta-analysis of four observational studies involving 153 000 patients showed an odds ratio of 2.36 (95% CI: 1.44-3.85; P = 0.0006) for SSRI associated UGIH. The odds ratio increased to 6.33 (95% CI: 3.40-11.8; P < 0.00001) with concomitant NSAIDs. In patients aged above 50 years with no UGIH risk factors, the Number-Needed-to-Harm per year is 411 for SSRIs alone, and 106 with concomitant NSAIDs. Analysis of 101 spontaneous reports showed that UGIH occurred after a median of 25 weeks with SSRIs. Around 67% of these patients were on NSAIDs.
Conclusions:
Selective serotonin reuptake inhibitor use, alone and in combination with NSAIDs, substantially increases the risk of UGIH. Clinicians should consider this when managing patients at risk of, or presenting with UGIH.
Related Concept Videos
Drug toxicity: Drug–Drug Interaction
Drugs for Treatment of Ulcerative Colitis in IBD
Drugs Affecting GI Tract Motility: Serotonin Receptor Agonists
Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
Factors Influencing Drug Absorption: Disease States and Pharmacology
Substances such as alcohol and specific drugs, including antineoplastics, can also negatively impact drug absorption. For instance,...
Drugs for Peptic Ulcer Disease: Prostaglandin Analogs as Mucosal Protective Agents
Non-steroidal anti-inflammatory drugs (NSAIDs) can induce peptic ulcers by inhibiting cyclooxygenase, decreasing...