Aspirin with Paroxetine Interaction Details

Brand Names Associated with Aspirin

Brand Names Associated with Paroxetine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Mar 04, 2024

Interaction Effect

An increased risk of bleeding

Interaction Summary

Use caution with the concomitant use of NSAIDs and antidepressants, including SSRIs due to an increased risk of intracranial hemorrhage[1] and gastrointestinal (GI) bleeding [2]. Bleeding events have included epistaxis, ecchymosis, hematoma, petechiae, and life-threatening hemorrhages [3]. When an SSRI and an NSAID are given concurrently, closely monitor the patient for signs of adverse events, including GI bleeds, especially in elderly and those with a history of GI ulcers. Consider other types of pain management (eg, acetaminophen), review the chosen antidepressant (ie, consider agents with less serotonin reuptake inhibition), or prescribe prophylaxis with antiulcer drugs [4].

Severity

Major

Onset

Unspecified

Evidence

Established

How To Manage Interaction

Use caution if NSAIDs and SSRIs are coadministered. Concomitant use of NSAIDs and SSRIs may cause an increased risk of intracranial hemorrhage[1] and gastrointestinal (GI) bleeding [5][6]. When an SSRI and an NSAID are given concurrently, closely monitor the patient for signs of adverse events, including GI bleeds, especially in elderly and those with a history of GI ulcers. Consider other types of pain management (eg, acetaminophen), review the chosen antidepressant (ie, consider agents with less serotonin reuptake inhibition), or prescribe prophylaxis with antiulcer drugs [4].

Mechanism Of Interaction

Depletion of platelet serotonin by SSRI; additive effects on hemostasis

Literature Reports

A) Concomitant use of NSAIDs and antidepressants, including tricyclic antidepressants, SSRIs, serotonin-norepinephrine reuptake inhibitors, and MAOIs, resulted in a 60% increased risk of intracranial hemorrhage within 30 days of concomitant use compared with antidepressant use alone. There was no significant difference between the antidepressant drug classes and the increased risk; however, there was an increased risk associated with male patients compared with female patients [1].

B) SSRIs increase the risk of upper gastrointestinal (GI) bleeding, and this effect is potentiated by concurrent use of NSAIDs or low-dose aspirin. Hospitalizations for upper GI bleeding were searched among 26,005 users of antidepressant medications and compared with the number of hospitalizations in those patients who did not receive prescriptions for antidepressants. The amount of upper GI bleeding episodes was 3.6 times more than expected. Combined use of an SSRI and NSAIDs or low-dose aspirin increased the risk to 12.2 and 5.2 times, respectively. The findings of this study demonstrate an increased risk of upper GI bleeding during the use of SSRIs. Combined use of SSRIs and NSAIDs or low-dose aspirin increased the risk even further [3].

C) Two metaanalyses of incidents of upper GI bleed due to SSRIs, NSAIDs, and their combination found that SSRIs increased the risk by 1.73 [2] to 2.36 times [7], NSAIDs by 2.55 times [2], and the combination of SSRIs and NSAIDs by 4.02 [2] to 6.33 times [7].

D) The release of serotonin by platelets is important for maintaining hemostasis. Case-control and cohort studies have shown that the combined use of SSRIs and NSAIDs have been associated with an increased risk of bleeding [8].

References

1 ) Shin JY, Park MJ, Lee SH, et al: Risk of intracranial haemorrhage in antidepressant users with concurrent use of non-steroidal anti-inflammatory drugs: nationwide propensity score matched study. BMJ 2015; 351:h3517.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

2 ) Oka Y, Okamoto K, Kawashita N, et al: Meta-analysis of the risk of upper gastrointestinal hemorrhage with combination therapy of selective serotonin reuptake inhibitors and non-steroidal anti-inflammatory drugs. Biol Pharm Bull 2014; 37(6):947-953.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

3 ) Dalton S, Johansen C, Mellemkjoer L, et al: Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding. Arch Intern Med 2003; 163:59-64.

4 ) Mort JR, Aparasu RR, & Baer RK: Interaction between selective serotonin reuptake inhibitors and nonsteroidal antiinflammatory drugs: review of the literature. Pharmacotherapy 2006; 26(9):1307-1313.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

5 ) Product Information: VIMOVO(TM) delayed release oral tablets, naproxen and esomeprazole magnesium delayed release oral tablets. AstraZeneca LPW, Wilmington, DE, 2010.

6 ) Product Information: SPRIX(TM) nasal spray, ketorolac tromethamine nasal spray. Roxro Pharma, Inc, Menlo Park, CA, 2009.

7 ) 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; 27(1):31-40.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

8 ) Product Information: CELEXA(R) oral tablets, citalopram oral tablets. Allergan USA Inc (per FDA), Madison, NJ, 2023.

Aspirin Overview

• Prescription aspirin is used to relieve the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), osteoarthritis (arthritis caused by breakdown of the lining of the joints), systemic lupus erythematosus (condition in which the immune system attacks the joints and organs and causes pain and swelling) and certain other rheumatologic conditions (conditions in which the immune system attacks parts of the body). Nonprescription aspirin is used to reduce fever and to relieve mild to moderate pain from headaches, menstrual periods, arthritis, toothaches, and muscle aches. Nonprescription aspirin is also used to prevent heart attacks in people who have had a heart attack in the past or who have angina (chest pain that occurs when the heart does not get enough oxygen). Nonprescription aspirin is also used to reduce the risk of death in people who are experiencing or who have recently experienced a heart attack. Nonprescription aspirin is also used to prevent ischemic strokes (strokes that occur when a blood clot blocks the flow of blood to the brain) or mini-strokes (strokes that occur when the flow of blood to the brain is blocked for a short time) in people who have had this type of stroke or mini-stroke in the past. Aspirin will not prevent hemorrhagic strokes (strokes caused by bleeding in the brain). Aspirin is in a group of medications called salicylates. It works by stopping the production of certain natural substances that cause fever, pain, swelling, and blood clots.

• Aspirin is also available in combination with other medications such as antacids, pain relievers, and cough and cold medications. This monograph only includes information about the use of aspirin alone. If you are taking a combination product, read the information on the package or prescription label or ask your doctor or pharmacist for more information.

Paroxetine Overview

• Paroxetine tablets, suspension (liquid), and extended-release (long-acting) tablets are used to treat depression, panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Paroxetine tablets and suspension are also used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), generalized anxiety disorder (GAD; excessive worrying that is difficult to control), and posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience). Paroxetine extended-release tablets are also used to treat premenstrual dysphoric disorder (PMDD, physical and psychological symptoms that occur before the onset of the menstrual period each month). Paroxetine capsules (Brisdelle) are used to treat hot flashes (sudden feelings of warmth, especially in the face, neck, and chest) in women who are experiencing menopause (stage of life when menstrual periods become less frequent and stop and women may experience other symptoms and body changes). Paroxetine is in a class of medications called selective serotonin-reuptake inhibitors (SSRIs). It treats depression and other mental illnesses by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. There is not enough information available at this time to know how paroxetine works to treat hot flashes.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.