SSRIs and anticoagulant medication

[LRH77]

I've just been prescribed an SSRI for anxiety and noticed in the info leaflet that it can increase your bleeding risk. I'm prescribed clopidogrel and interferon, and I'm just wondering if others out there are on a similar regime (I just want to feel reassured prior to starting that I'm not putting myself at increased risk) - my GP obviously knows what other medication I'm on and was more interested in the fact that I'm on Lansoprazole to protect my stomach lining! Many thanks for reading ☺️

[Cat1001954]

hi I’m on clopidigrel hydroxycarbamide and lansoprazole no worries

[LRH77 in reply to Cat1001954]

Thank you. I was actually querying about the effects of adding an SSRI (antidepressant) in to the mix, as these can increase risk of bleeding apparently... I'd be interested to know if anyone is prescribed this as well! 🤔

[Cat1001954 in reply to LRH77]

Yes I just said I’m on lansoprazole with taking hydra and Clopidigrel. With no problems Bern in them 6 months

[LRH77 in reply to Cat1001954]

I think our wires are getting crossed! No worries, thank you for your reply. Lansoprazole is to protect the stomach lining, I've been taking that for years. My question was about the antidepressant I've just been prescribed

[Cat1001954 in reply to LRH77]

Oh I get you Iv been on mirtazapine for years for depression also

[hunter5582]

You are correct to thinks there is potential increased risk of hemorrhage when combining a SSRI with clopidogrel. The degree of risk may depend on which SSRI you are taking. Here are two examples using ePocrates to check for intersections.

Avoid/Use Alternative clopidogrel + fluoxetine avoid combo: combo may decr. clopidogrel active metabolite levels, efficacy; may incr. risk of bleeding, incl. life-threatening (hepatic metab. inhibited, decr. conversion of clopidogrel to active metabolite; additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

Monitor/Modify Tx citalopram + clopidogrel monitor bleeding s/sx; adjust max citalopram dose to 20 mg/day: combo may incr. citalopram levels, risk of QT prolongation, cardiac arrhythmias, bleeding (incl. life-threatening), other adverse effects (hepatic metab. inhibited, additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

The short explanation is that Selective Serotonin Reuptake Inhibitors act on serotonergic circuits in the brain to achieve the therapeutic benefit. Serotonin reuptake is also involved in how the platelets work to stop bleeding. This is why SSRIs can impact platelet activity.

Suggest that you review the specific SSRI in question with a pharmacist to best assess whether the combination is advisable. Note that there are other anxiolytic medications that do not carry the hemorrhage risks associated with SSRIs or SNRIs. These include medications like buspirone, hydroxyzine, and benzodiazepines. Each of these medications come with their own risk/benefit profile which you would need to review with a medical provider who knows your case. Ideally, this would be a psychiatrist rather than a GP as your case is complex enough that you would benefit from a higher level of expertise.

Please be sure to consult with a medical provider to get the best advice on how to proceed. Given that anxiety is a potential adverse effect from Pegasys and you are dealing with potential for hemorrhage risk, consultation with your MPN Specialist would also be advisable. `

WIshing you all the best. Please do let us know what you learn.

[LRH77 in reply to hunter5582]

Thank you for your informative reply. I'll get in touch with an MPN specialist if I'm able. I've been prescribed citalopram, so there are obviously risks with that particular medication... I'll let you know what I find out.Best wishes

[Amethist]

you could check with your local pharmacist too.

[Anag]

doctors are extremely busy and there are thousands of drugs. It’s bad enough trying to balance the interactions of two drugs. If a patient is taking 3 or more it become exponentially impossible. My month mother-in-law almost died within a week of starting a new medication. She was a pretty healthy 92-year-old and was given antidepressants because her husband of 77 years had died. The doctor said it is standard of care to give old people anti-depressants. She had a depressed day in her life and she was doing really well after his death.

the anti-depressants together with another medication caused an unbelievable deficit in electrolytes and almost led to heart failure. She started feeling before our eyes and no one knew why. I researched for three hours all the possible combinations with her med and I found the culprit. Luckily, I myself had an appointment at my cardiologist and asked her about these two meds. She said to stop the antidepressants immediately before her heart stops. We did that and the Dr. gave her IV electrolytes. In three days later she was back on her feet and we still had her for another two beautiful years.

we believe strongly and using natural alternatives to drugs wherever it’s possible. It is usually safe unless you’re on aspirin and also taking ginkgo or turmeric, for example. It is necessary to have a good alternative Dr. to guide you! At the same time, we must educate ourselves regarding our own health in this very complicated world. my mother-in-law had PLT 80. The same doctor left her taking Ginkgo. I noticed she had been bruising everywhere even when she lightly fell against the wall! Her children were saying, let the doctors do their job. I stopped the ginkgo, the bruising stopped, she felt better. We must work with the doctors

Regarding panic, I was given Passaflora (Passion flower) drops and they worked beautifully without being a burden to my liver or interacting with drugs that I was taking. It’s worth looking into. It does increase the time needed for blood to clot a bit. On days that I take it, I take a 50mg aspirin instead of 100mg. Or I take the 50mg aspirin the next day. : )

hope to have helped. Anag 🙂

[Camelian]

I take an SSRI and aspirin and have done for a number of years. My understanding is there is a risk of bleeds taking both and I'm thinking of reducing the SSRI gradually and looking for a more natural remedy. In addition to taking the SSRI and aspirin I'm also on a a reducing regime of steroids for Polymyalgia rheumatic and the combination of all three play havoc on my stomach so to reduce the acid I take lansoprazol. Recently I was told my dexa scan showed osteopenia this I believe is due to the steroids. I can't just stop the steroids unfortunately so I spoke to my GP about reducing landsoprazol from 30mg to 15mg because landsoprazol also effects the bones but the problem is I'm now I'm back to getting acid reflux which is also a risk so it's just so hard to know what to do for the best. I think I'm going to try and find a good alternative therapist to discuss some natural options. Good luck and please let us know how you get on .Take care.