Meta‐analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non‐steroidal anti‐inflammatory drugs

Loke, YK; Trivedi, Apurva; Singh, Sonal

doi:10.1111/j.1365-2036.2007.03541.x

Cited by 159 publications

(78 citation statements)

References 18 publications

(23 reference statements)

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“…Four of the articles included in the present study 2,3,9,10) reported a >2-times higher risk of UGIH with combination use vs. SSRIs alone, whereas none of the six articles reported the same risk increase for the use of NSAIDs alone. This suggests that the risk of UGIH with combination use of SSRIs and NSAIDs is higher than the additive effect of each type of drug alone (Fig.…”

Section: Discussionmentioning

confidence: 67%

“…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%

“…Among these six reports, 2,3,[8][9][10][11] one was a study on the drug interaction between SSRI and NSAIDs, 9) and four also included the interactions of non-SSRIs (serotonin noradrenaline receptor inhibitors; SNRIs) or tricyclic antidepressants (TCAs). 2,8,10,11) The remaining study was a meta-analysis on the interaction between SSRIs and NSAIDs.…”

Section: Data Searchmentioning

confidence: 99%

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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: 67%

Section: Discussionmentioning

confidence: 91%

Section: Data Searchmentioning

confidence: 99%

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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 well established that the risk of association between NSAIDs and peptic disease and its complications, also depends on other risk factors inherent to the patient, including advanced age, presence of co-morbidities, concomitant drugs, smoking and a history of peptic ulcer disease and bleeding (126,205) . The risk of NSAIDs causing ulceration and bleeding also varies with the toxicity, dosage and duration of the medication used (185) .…”

Section: Statement 24mentioning

confidence: 99%

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

Coelho

Maguinilk

Zaterka³

et al. 2013

Arq. Gastroenterol.

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Significant progress has been obtained since the Second Brazilian Consensus Conference on Helicobacter pylori Infection held in 2004, in São Paulo, SP, Brazil, and justify a third meeting to establish updated guidelines on the current management of H. pylori infection. The Third Brazilian Consensus Conference on H pylori Infection was organized by the Brazilian Nucleus for the Study of Helicobacter, a Department of the Brazilian Federation of Gastroenterology and took place on April 12-15, 2011, in Bento Gonçalves, RS, Brazil. Thirty-one delegates coming from the five Brazilian regions and one international guest, including gastroenterologists, pathologists, epidemiologists, and pediatricians undertook the meeting. The participants were allocated in one of the five main topics of the meeting: H pylori, functional dyspepsia and diagnosis; H pylori and gastric cancer; H pylori and other associated disorders; H pylori treatment and retreatment; and, epidemiology of H pylori infection in Brazil. The results of each subgroup were submitted to a final consensus voting to all participants. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Seventy per cent and more votes were considered as acceptance for the final statement. This article presents the main recommendations and conclusions to guide Brazilian doctors involved in the management of H pylori infection.

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“…Csoka, Bahrick & Mehtonen (2008) report that sexual dysfunction can continue even after drugs are discontinued. Serotonin transporters, the target for the SSRIs, are also found on blood platelets and SSRIs are associated with risk of bleeding ulcers (Loke, Trivedi, and Singh, 2008;Serebruany, 2006) and stroke (Wu, Wang, Cheng, & Gau, 2011).…”

Section: Adverse Effects Short Termmentioning

confidence: 99%