nsNSAIDs, other drugs and GI bleed

Q: 58 years old male with previous history of osteoarthritis, and chronic depression is admitted to ICU with gastrointestinal bleed (GIB). The risk of GIB increases in the patient who takes Nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs) along with selective serotonin reuptake inhibitors (SSRI).

A) True

B) False

Answer: True

Although nsNSAIDs can indeed increase GI symptoms such as dyspepsia, peptic ulcer disease (PUD), and GIB, these symptoms get augmented due to other drugs on the patient's profile. These include concurrent use of glucocorticoids, antiplatelet agents (eg, aspirin, clopidogrel and anticoagulants. It is less known that SSRIs also increase such risk.

The other risk factors of GIB from nsNSAIDs are prior history of GI ulcer or GIB, older age, taking high NSAID dose, and underlying Helicobacter pylori infection.

#pharmacology

#GI

References:

1. Alam SM, Qasswal M, Ahsan MJ, Walters RW, Chandra S. Selective serotonin reuptake inhibitors increase risk of upper gastrointestinal bleeding when used with NSAIDs: a systemic review and meta-analysis. Sci Rep. 2022 Aug 24;12(1):14452. doi: 10.1038/s41598-022-18654-2. PMID: 36002638; PMCID: PMC9402708.

2. de Jong JC, van den Berg PB, Tobi H, de Jong-van den Berg LT. Combined use of SSRIs and NSAIDs increases the risk of gastrointestinal adverse effects. Br J Clin Pharmacol. 2003 Jun;55(6):591-5. doi: 10.1046/j.0306-5251.2002.01770.x. PMID: 12814454; PMCID: PMC1884264.

3. Loke YK, Trivedi AN, Singh S. Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2008 Jan 1;27(1):31-40. doi: 10.1111/j.1365-2036.2007.03541.x. Epub 2007 Oct 5. PMID: 17919277.