PHOENIX—Selective serotonin reuptake inhibitors are associated with an increased risk for gastrointestinal bleeding, but co-prescribing proton pump inhibitors may mitigate this effect, according to a literature review presented at ACG 2025.
“A lot of patients are on SSRIs,” said presenter Hina Wazir, MD, a resident at Jamaica Hospital Medical Center, in New York City. Although serotonin mediates platelet aggregation and SSRIs may impair hemostasis, she added, “there was not good data on those medicines and GI bleeds.”
Dr. Wazir and co-investigators searched the PubMed, Embase, and Cochrane databases and identified 13 studies examining the relationship between SSRIs and GI bleeding, all of which found an increased risk for bleeding in patients taking these medications (abstract P3064).
The investigators found that the relative risk of GI bleeding was dose dependent and increased more than twofold when SSRIs were taken concomitantly with nonsteroidal anti-inflammatory drugs or anticoagulants (Table). Serotonin-norepinephrine reuptake inhibitors, on the other hand, were not correlated with increased bleeding risk, Dr. Wazir said.
Additionally, proton pump inhibitors appeared to mitigate risk.
| Table. The Effect of SSRIs on GI Bleeding | |
| Medication use | Relative bleeding risk |
|---|---|
| SSRI use alone |
|
| SSRI (higher dose) |
|
| SSRI + NSAID/anticoagulant |
|
| SSRI + PPI |
|
| NSAID, non-steroidal anti-inflammatory drug; PPI, proton pump inhibitor; SSRI, selective serotonin reuptake inhibitor. | |
Although more studies are needed to better understand the correlation between SSRIs and bleeding, Dr. Wazir said she hopes the findings encourage healthcare providers to carefully weigh the benefits of these medications against bleeding risk, prescribe the lowest effective dose, and consider adding a PPI in high-risk patients.
—Katie Prince
Dr. Wazir reported no relevant financial disclosures.