Prescribing NSAIDs to patients on SSRIs: possible adverse drug interaction of importance to dental practitioners.
Abstract: The potential for adverse drug interactions is a growing concern for dental practitioners. Recent studies report an increased risk of gastrointestinal (GI) bleeding when nonsteroidal antiinflammatory drugs (NSAIDs) are taken concomitantly with selective serotonin reuptake inhibitors (SSRIs) than when either class of drugs is taken alone. A PubMed structured search was performed for published English language literature analyzing the epidemiology of this interaction between January 1, 1997 and December 31, 2007. Four cohort and five case-control studies were included in the final selection. Most studies show an increased risk for developing GI bleeding with concurrent use of SSRIs and NSAIDs, reporting an odds ratio between 1.8 and 15.6. Seven studies were done on adult European Caucasian populations, one in Canada, and one in the United States, with follow-up data collected ranging from 6 months to 13 years. The primary limitation was the variation in methodology, inclusion criteria, comparison groups, and statistical analyses. A significant correlation between the combination of these drugs and GI bleeding has been reported in retrospective studies. Nonetheless, a causal inference cannot be made based on the available evidence and the lack of randomized controlled clinical trials.
Pinto
Andres
A
Oral Medicine Clinical Center, Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, Philadelphia, Pennsylvania, USA.
Farrar
John T
JT
Hersh
Elliot V
EV
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000928:Antidepressive Agents / Q000009:adverse effects; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors