[MOL] Selective serotonin reuptake inhibitors are linked to a moderate r [00613] Medicine On Line


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[MOL] Selective serotonin reuptake inhibitors are linked to a moderate risk of gastrointestinal bleeding....



SSRIs Linked to GI Bleeds

25 October 1999: Selective serotonin reuptake inhibitors are linked to a moderate risk of gastrointestinal bleeding, according to Saturday's BMJ (1999; 319: 1106-9; www.bmj.org). The authors equate the risk to that of low-dose ibuprofen, amounting to about 1 person in 8000, but they find that concomitant use of nonsteroidal anti-inflammatory agents or aspirin with SSRIs "greatly increases the risk."

The analysis identified 1,651 cases of upper g.i. bleeding and 248 cases of ulcer perforation. Cases were compared with 10,000 matched controls without bleeds. SSRIs were used by 3.1% of cases, compared with 1.0% of controls, giving an adjusted rate ratio of 3.0. When SSRIs were combined with NSAIDs, this ratio jumped to 15.6, and it was 7.2 in cases who were taking low-dose aspirin with SSRIs.

Reprints: F. J. de Abajo, Agencia Espanola del Medicamento, 28220 Majadahonda, Madrid, Spain; fabajo@agemed.es.

An editorialist advises greater caution in general practice based on these findings, but he emphasizes its lack of controls over nonprescription-drug use in calling for more study (pp. 1081-2). "Over the counter antihistamines such as chlorpheniramine and diphenhydramine, which bind to the serotonin transporter and show selectivity towards it, and COX inhibitors, such as aspirin and ibuprofen, are widely used," he writes. "Such use may confound estimates of risk."

Warmly, lillian
 
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