title: [SSRI - treatment and bleeding. What risks do we take?].
abstract: Treatment with selective serotonin reuptake inhibitors (SSRI) increases the risk of gastrointestinal bleeding. The combination with non-steroidal anti-inflammatory drugs (NSAIDs) further augments this hazard. Particular precaution is also necessary in patients on platelet aggregation inhibitors, with a known bleeding disorder or preceding gastrointestinal lesions. The incidence of bleeding events apart from the gastrointestinal tract, e.g. intracerebral hemorrhages, is not cumulated under SSRI treatment. This also applies for the combination of SSRI and coumarin or aspirin. Prescribing doctors have to be aware of the bleeding risks of SSRI and should explain this to their patients. High-risk patients have to be followed up closely and an SSRI with a low potential for drug interaction should be used. The prescription of gastroprotective agents and a change of the antidepressant should be considered in particular cases. We provide a literature survey and recommendations for the clinical routine.
authors.affiliation: Klinikum rechts der Isar, Klinik und Poliklinik für Psychiatrie und Psychotherapie der TU München, Ismaningerstrasse 22, 81675, München, Deutschland. strubel@lrz.tu-muenchen.de
authors.forename: T
authors.initials: T
authors.lastname: Strubel
authors.forename: A
authors.initials: A
authors.lastname: Birkhofer
authors.forename: G
authors.initials: G
authors.lastname: Mössmer
authors.forename: H
authors.initials: H
authors.lastname: Förstl
mesh_terms: D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D018570:Risk Assessment; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
references.citation: Blood Coagul Fibrinolysis. 1997 Nov;8(8):517-23
references.pmid: 9491270
references.citation: Eur J Clin Pharmacol. 2001 May;57(2):167-76
references.pmid: 11417450
references.citation: J Intern Med. 2007 Mar;261(3):205-13
references.pmid: 17305643
references.citation: Arch Intern Med. 2008 Jan 28;168(2):180-5
references.pmid: 18227365
references.citation: J Clin Psychopharmacol. 2005 Dec;25(6):561-4
references.pmid: 16282838
references.citation: Clin Pharmacol Ther. 2000 Oct;68(4):435-42
references.pmid: 11061584
references.citation: Dialogues Clin Neurosci. 2007;9(1):47-59
references.pmid: 17506225
references.citation: J Clin Psychopharmacol. 2008 Apr;28(2):230-4
references.pmid: 18344737
references.citation: Acta Psychiatr Scand. 2000 Oct;102(4):250-5
references.pmid: 11089724
references.citation: Pharmacotherapy. 2006 Sep;26(9):1307-13
references.pmid: 16945053
references.citation: Basic Clin Pharmacol Toxicol. 2006 Mar;98(3):304-10
references.pmid: 16611206
references.citation: Transl Res. 2008 Mar;151(3):168-72
references.pmid: 18279816
references.citation: Arch Intern Med. 2003 Jan 13;163(1):59-64
references.pmid: 12523917
references.citation: Drug Saf. 2004;27(14):1157-65
references.pmid: 15554748
references.citation: Arch Intern Med. 2003 Oct 27;163(19):2354-8
references.pmid: 14581256
references.citation: Eur J Pharmacol. 1997 Dec 11;340(2-3):249-58
references.pmid: 9537821
references.citation: Circulation. 2001 Oct 16;104(16):1894-8
references.pmid: 11602490
references.citation: Drug Saf. 2008;31(2):159-68
references.pmid: 18217791
references.citation: BMJ. 2000 May 20;320(7246):1405-6
references.pmid: 10858059
references.citation: Circulation. 2003 Aug 26;108(8):939-44
references.pmid: 12912814
references.citation: Expert Opin Drug Saf. 2005 Mar;4(2):337-44
references.pmid: 15794724
references.citation: J Clin Psychopharmacol. 1993 Feb;13(1):75-6
references.pmid: 8486822
references.citation: Aliment Pharmacol Ther. 2005 Aug 1;22(3):175-81
references.pmid: 16091054
references.citation: Stroke. 2002 Jun;33(6):1465-73
references.pmid: 12052976
references.citation: Aliment Pharmacol Ther. 2006 Apr 1;23(7):937-44
references.pmid: 16573796
references.citation: Am J Med. 2006 Sep;119(9):719-27
references.pmid: 16945603
references.citation: Fortschr Neurol Psychiatr. 1998 Jan;66(1):32-5
references.pmid: 9530554
references.citation: Am J Med. 2006 Feb;119(2):113-6
references.pmid: 16443409
references.citation: Br J Clin Pharmacol. 2008 Jul;66(1):76-81
references.pmid: 18460039
references.citation: Stroke. 2007 Nov;38(11):3049-51
references.pmid: 17901378
references.citation: Aliment Pharmacol Ther. 2008 Jan 1;27(1):31-40
references.pmid: 17919277
references.citation: Arch Intern Med. 2004 Nov 22;164(21):2367-70
references.pmid: 15557417
references.citation: BMJ. 2001 Sep 22;323(7314):655-8
references.pmid: 11566827
references.citation: Thromb Haemost. 2002 Nov;88(5):705-10
references.pmid: 12428081
references.citation: Br J Clin Pharmacol. 2000 Jul;50(1):43-7
references.pmid: 10886117
references.citation: Br J Clin Pharmacol. 2003 Jun;55(6):591-5
references.pmid: 12814454
references.citation: BMJ. 1999 Oct 23;319(7217):1106-9
references.pmid: 10531103