Publications

Published: December 2011

SSRIs - still associated with cases of bleeding

Prescriber Update 32(4): 31-32
December 2011

Healthcare professionals are reminded that selective serotonin reuptake inhibitors (SSRIs*) increase the risk of bleeding, possibly due to altering platelet function. Haemorrhages reported in association with the use of SSRIs include bruising, purpura, epistaxis, and peri-operative, vaginal, and gastrointestinal bleeding.1

CARM continues to receive reports of bleeds in which SSRIs have been identified as being a cosuspect medicine or may have contributed to the bleed. One such report describes a patient who experienced a subdural haematoma with severe consequences while taking warfarin and an SSRI. Importantly, the patient’s INR was found to be within the normal range.

The risk of bleeding appears to be higher when SSRIs are used with other medicines that are known to increase the risk of bleeding, such as anticoagulants and NSAIDs. Combining any SSRI and NSAIDs is thought to result in 1 in 250 patients experiencing an upper GI bleed if no acid suppressant agent is used.2

Healthcare professionals are advised to use caution when considering co-prescribing an SSRI with an anticoagulant or NSAIDs. Should an SSRI need to be prescribed with a NSAID, a proton pump inhibitor should also be considered.

Prescribers are recommended to inform patients to closely monitor for signs of bleeding and to seek urgent advice should this occur.

* The bleeding risk also applies to Venlafaxine, a Selective Serotonin Noradrenaline Reuptake Inhibitor (SNRI) with similar properties to the SSRIs.

References
  1. Prescriber Update. Increased risk of bleeding with SSRIs. Prescriber Update 2006; 27(2): 18-20.
  2. De Abajo FJ, Garcia-Rodriguez LA, et al. 2008. Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy: interaction with nonsteroidal anti-inflammatory drugs and effect of acid suppressive agents. Arch Gen Psychiatry: 65: 795-803.