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Risk of gastrointestinal bleeding by specific SSRIs and SNRIs: A systematic review and meta-analysis
Ainhoa Gomez-Lumbreras1, Abdelrahman G Tawfik1, Guilherme Del Fiol2
1Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.
British Journal of Clinical Pharmacology
|December 29, 2025
Summary
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) increase the risk of gastrointestinal bleeding (GIB). This risk is elevated for commonly used antidepressant products, particularly for patients already at higher risk of GIB.
Area of Science:
- Pharmacovigilance
- Gastroenterology
- Psychiatry
Background:
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are widely prescribed antidepressants.
- Gastrointestinal bleeding (GIB) is a potential adverse event associated with these medications.
Purpose of the Study:
- To estimate the individual risk of gastrointestinal bleeding (GIB) associated with specific selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
Main Methods:
- A systematic review and random-effect meta-analysis of 20 studies were conducted.
- Searches were performed in PubMed and EMBASE for unique antidepressants (SSRIs and SNRIs) and GIB risk.
- Included studies encompassed case-control, cohort, case-crossover, and randomized controlled trial designs.
Main Results:
- All analyzed antidepressants demonstrated an increased risk of GIB.
- Venlafaxine exhibited the highest estimated risk (OR 1.50), followed by citalopram and fluoxetine (OR 1.38).
- Paroxetine showed the lowest GIB risk among the studied agents (OR 1.31).
Conclusions:
- Gastrointestinal bleeding is an uncommon but significant adverse event.
- The use of commonly prescribed SSRIs and SNRIs is associated with an elevated risk of GIB.
- This finding is particularly relevant for patients with pre-existing risk factors for GIB.
Keywords:
antidepressive agentsgastrointestinal haemorrhageselective serotonin reuptake inhibitorsserotonin and noradrenaline reuptake inhibitorsMore Related Videos
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