Increased use of selective serotonin reuptake inhibitors in patients admitted with gastrointestinal haemorrhage: a multicentre retrospective analysis

Wessinger, Sarah; Kaplan, Muhammet Ali; Choi, Lillian; Williams, Mark; Lau, CY; Sharp, Lisa K.; Crowell, Michael D.; Ali, Keshavarzian; Jones, Michael P.

doi:10.1111/j.1365-2036.2006.02859.x

Cited by 85 publications

(62 citation statements)

References 19 publications

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“…However, the conclusions of past studies varied; some concluded that the risk was not increased with combination use, 4,8,12,13) whereas others concluded that risk was increased [1][2][3][9][10][11][14][15][16][17] compared to use of SSRIs or NSAIDs alone.…”

Section: Discussionmentioning

confidence: 91%

Meta-analysis of the Risk of Upper Gastrointestinal Hemorrhage with Combination Therapy of Selective Serotonin Reuptake Inhibitors and Non-steroidal Anti-inflammatory Drugs

Oka

Okamoto

Kawashita

et al. 2014

Biological & Pharmaceutical Bulletin

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It is thought that both selective serotonin reuptake inhibitors (SSRIs) and non-steroidal anti-inflammatory drugs (NSAIDs) can cause the adverse reaction of upper gastrointestinal hemorrhage (UGIH). To evaluate differences in the probability of UGIH occurring when SSRIs, NSAIDs, or both combined are administered, the authors performed a systematic review of related articles and a meta-analysis of data in those articles, which were identified by searching the literature published between 1999 and 2012 using PubMed, Scirus, and Google Scholar. The odds ratios were calculated using the Mantel-Haenszel method. The integrated odds ratios for SSRIs only, NSAIDs only, and the combination were 1.73 (0.65-2.82), 2.55 (1.51-3.59), and 4.02 (2.89-5.15), respectively. Use of the combination resulted in an odds ratio 2.32 times higher than use of either alone. Since the combination of SSRIs and NSAIDs resulted in a significantly higher risk of UGIH than either type of drug alone, clinicians should avoid use of the combination as much as possible. If it is necessary to administer both kinds of drugs, the minimum dosage should be prescribed for the shortest time period possible, and patients, particularly elderly patients, should be closely monitored for development of UGIH and other complications.Key words meta-analyses; epidemiology; combination use; non-steroidal anti-inflammatory drug (NSAID); selective serotonin reuptake inhibitor (SSRI); upper gastrointestinal hemorrhage (UGIH) Selective serotonin reuptake inhibitors (SSRIs) are widely used in the treatment of panic and obsessive compulsive disorders in many countries, and the effects have been confirmed. Usage of SSRIs is increasing because of their low toxicity compared with classical antidepressants, which have a different mode of action.1) Thus, among the many kinds of antidepressants available, SSRIs are currently the most commonly prescribed, and their usage has steadily increased in elderly patients with depression in particular.2) However, SSRIs are reported to have some specific adverse reactions, such as upper gastrointestinal hemorrhage (UGIH). 3)Non-steroidal anti-inflammatory drugs (NSAIDs), which are widely used over-the-counter drugs, have also been shown to be associated with a risk of UGIH.1) Although SSRIs and NSAIDs are sometimes administered in combination, 4) the harmful effects of this combination have not been clarified, as the Food and Drug Administration (FDA) has not accurately analyzed the risk of UGIH resulting from combination use of SSRIs and NSAIDs. 3)Therefore, we collected data for cases of UGIH resulting from the administration of SSRIs alone, NSAIDs alone, and combination use reported between 1999 and 2012, and performed a meta-analysis in order to analyze the risk of UGIH associated with combination use of SSRIs and NSAIDs. METHODS Literature SearchWe searched the literature through PubMed, Scirus, and Google Scholar for articles published between 1999 and 2012 using the following terms: "NSAIDs other drug interaction," "adverse intera...

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Section: Discussionmentioning

confidence: 91%

Meta-analysis of the Risk of Upper Gastrointestinal Hemorrhage with Combination Therapy of Selective Serotonin Reuptake Inhibitors and Non-steroidal Anti-inflammatory Drugs

Oka

Okamoto

Kawashita

et al. 2014

Biological & Pharmaceutical Bulletin

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“…It has been reported that concomitant use of SSRIs and NSAIDs increases gastrointestinal bleeding (9,13,14,24,25). In addition, an interaction between SSRIs and corticosteroids has been also suggested (24).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, some clinical studies have recently reported the association of SSRI medication and gastrointestinal bleeding (9,10). Recent case-control studies (9,(11)(12)(13) and cohort studies (14) have shown that the risk of upper difficult to judge whether a symptom is induced by depression itself or by an adverse reaction to drugs. Gastrointestinal symptoms and endoscopic findings in psychiatric patients have been reported in western countries (15).…”

Section: Introductionmentioning

confidence: 99%

Use of Selective Serotonin Reuptake Inhibitors and Upper Gastrointestinal Disease

et al. 2011

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Background Selective serotonin reuptake inhibitors (SSRIs) are the most widely used antidepressants in the world. Recent studies, however, have raised the concern that SSRIs increase the risk of gastrointestinal dysfunction. Therefore, we conducted a case-control study on gastrointestinal symptoms and endoscopic findings in patients who were taking SSRIs in Japan. Methods Forty-one patients who were taking SSRIs (SSRI-treated group) and 82 age-and sex-matched patients who were not taking antidepressants (control group) were selected from the population of patients who underwent endoscopic examination from January 1, 2005 to March 31, 2010 in our institution, and their subjective symptoms and endoscopic findings were analyzed. Patients who were taking proton pump inhibitors (PPIs) and/or histamine H2-receptor antagonists (H2RAs) were excluded from this study. Results The chief complaints at the endoscopic examination were classified into the following 4 categories: reflux symptoms, dysmotility symptoms, ulcer-like symptoms, and no upper abdominal symptoms. No significant difference was found in the complaint rate of each category between the SSRI-treated and the control groups. No significant differences were found between the groups in endoscopic findings, the LANZA score and the rate of chief complaints in patient classes stratified by the endoscopic finding. Conclusion It was not evident that SSRIs induced mucosal damage of the upper gastrointestinal tract. And, it is considered that SSRIs do not increase the risk of upper gastrointestinal symptoms in patients treated with SSRIs for 1 month or longer. The present study suggests that SSRI medication does not have a bad influence on gastrointestinal symptoms and gastrointestinal organic diseases.

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“…Concomitant use of aspirin or other NSAIDs may potentiate the tendency to bleeding (Oyesanmi et al, 1999;Reeves et al, 2007). There is an increased risk of gastrointestinal haemorrhage (GIH) in patients prescribed SSRIs (Wessinger et al, 2006). SSRI use was more strongly associated with lower [OR (95% CI) 1.8 (1.2-2.8)] rather than upper [1.3 (0.83-1.9)] GIH.…”

Section: Other Dyscrasias Associated With Psychoactive Drug Treatmentmentioning

confidence: 99%

Haematological toxicity of drugs used in psychiatry

Flanagan

Dunk

2007

Hum. Psychopharmacol. Clin. Exp.

193

154

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Increased use of selective serotonin reuptake inhibitors in patients admitted with gastrointestinal haemorrhage: a multicentre retrospective analysis

Abstract: SUMMARY BackgroundSelective serotonin reuptake inhibitors (SSRIs) can adversely affect platelet function and impair haemostasis. Various bleeding complications have been reported in persons taking SSRIs including an increased risk of gastrointestinal haemorrhage (GIH).

Cited by 85 publications

References 19 publications

Meta-analysis of the Risk of Upper Gastrointestinal Hemorrhage with Combination Therapy of Selective Serotonin Reuptake Inhibitors and Non-steroidal Anti-inflammatory Drugs

Meta-analysis of the Risk of Upper Gastrointestinal Hemorrhage with Combination Therapy of Selective Serotonin Reuptake Inhibitors and Non-steroidal Anti-inflammatory Drugs

Use of Selective Serotonin Reuptake Inhibitors and Upper Gastrointestinal Disease

Haematological toxicity of drugs used in psychiatry

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