Concurrent use of nonsteroidal anti-inflammatory drugs and selective serotonin reuptake inhibitors increases the risk for gastrointestinal bleeding, compared with either NSAIDs or SSRIs alone, according to a new systematic review and network meta-analysis. The data suggest that prescribers should exercise caution when administering NSAIDs and SSRIs concurrently, especially in patients with higher risk for bleeding, the authors wrote.
The use of NSAIDs and SSRIs has dramatically increased over the past two decades, the researchers noted (Front Psychol 2020;11:35. doi:10.3389/fpsyt.2020.00035), so the researchers set out to understand the increasing prescriptions’ effect on bleeding. “It is important to understand this risk of [the] side-effect profile [of these drugs]—particularly GI [bleeding]—as it can decrease the quality of life and increase consumption of healthcare resources,” they wrote.
The researchers conducted a comprehensive literature search from inception to Nov. 10, 2021, using MEDLINE, Embase, Web of Science Core Collection, SciELO, KCI and Cochrane databases. They excluded case reports, case studies, editorials, guidelines and review articles, but included comparative studies.
The search yielded 15 studies published between 1999 and 2017, with data from a total of 82,605 patients. The researchers found the rates of GI bleeding were higher in patients taking both medications than in those taking either medication alone. Most of the studies (n=11) reported higher rates of GI bleeding in the group taking both NSAIDs and SSRIs than in those taking only SSRIs (36.9% vs. 22.8%; odds ratio [OR], 2.14; 95% CI, 1.52-3.02; P<0.001). In addition, 10 studies reported more GI bleeding in the group using both SSRIs and NSAIDs than those using only NSAIDs (40.9% vs. 34.2%; OR, 1.49; P<0.001).
Due to the limited meta-analysis data, the researchers could not stratify the results based on type of SSRI or NSAID, type of GI bleed, comorbidities, use of proton pump inhibitors or patient characteristics.
But they noted that this meta-analysis, which was the first of its kind, with a large-scale set of data evaluating the effects of use of SSRIs, NSAIDs, and a combination of the two medications on upper and lower GI bleeding "will have increased implications as more patients are being prescribed the medications concurrently.” They recommended that "prescribers exercise caution in prescribing [these NSAIDs and SSRIs] simultaneously and monitor the patients more closely for signs of GI bleed.”
—Joe Morreale
