Aspirin and Sertraline: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Sertraline
No brand names on recordAspirin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Taking sertraline (an antidepressant) together with aspirin can raise your chance of bleeding. Here's why: aspirin already makes your platelets (the cells that help you form clots) less sticky. Sertraline works on a chemical called serotonin, and it turns out platelets need serotonin to clump together too. So the two drugs add up and make it a little harder for your body to stop bleeding.
This can show up as easy bruising, nosebleeds, or, more seriously, stomach bleeding. The good news is your care team can manage this. Please don't stop either medicine on your own, just talk with your pharmacist or doctor about the safest plan for you.
Effect: Additive increased bleeding risk (GI and intracranial hemorrhage). Severity: major; evidence: established.
Mechanism: SSRIs like sertraline inhibit serotonin reuptake into platelets, depleting platelet serotonin and impairing serotonin-mediated aggregation. Aspirin irreversibly inhibits platelet COX-1/thromboxane. The effects on hemostasis are additive (PD interaction, not CYP-mediated).
Management:
- Monitor for epistaxis, ecchymosis, petechiae, hematoma, and especially GI bleeding, notably in elderly patients and those with prior ulcers.
- Consider acetaminophen for analgesia where appropriate.
- Consider an antidepressant with less serotonergic activity.
- Consider gastroprotection (eg, antiulcer prophylaxis) if concurrent use continues.
What happens
An increased risk of bleeding
Interaction Deep Dive
Combining NSAIDs with antidepressants such as SSRIs warrants caution, since doing so raises the likelihood of both intracranial hemorrhage1 and gastrointestinal (GI) bleeding 6. Reported bleeding manifestations range from epistaxis, ecchymosis, hematoma, and petechiae to hemorrhages that are life-threatening 5. During concurrent administration of an SSRI and an NSAID, watch the patient carefully for indications of adverse effects such as GI bleeds, with particular attention to elderly individuals and anyone with a prior history of GI ulcers. Options to weigh include alternative pain control strategies (for example, acetaminophen), reassessment of the selected antidepressant (that is, favoring agents that inhibit serotonin reuptake to a lesser degree), or the addition of prophylactic antiulcer medication 4.
Why it happens (mechanism)
Depletion of platelet serotonin by SSRI; additive effects on hemostasis
How to manage this interaction
If you have been prescribed both, keep taking them as directed unless your prescriber tells you otherwise. Your care team can manage this interaction.
- Watch for bleeding signs: unusual bruising, nosebleeds, pink or red tiny skin spots, black or tarry stools, or vomit that looks like coffee grounds. Report these promptly.
- Ask about pain options: your team may suggest acetaminophen instead of aspirin for pain when that fits your needs.
- Stomach protection: if you keep taking both, your prescriber may add a stomach-protecting medicine, especially if you are older or have had ulcers.
- Review your antidepressant: your team may consider one with less effect on serotonin.
Bring these questions to your pharmacist or doctor.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) Taking NSAIDs together with antidepressants, such as tricyclic antidepressants, SSRIs, serotonin-norepinephrine reuptake inhibitors, and MAOIs, produced a 60% higher risk of intracranial hemorrhage within 30 days of combined use when compared with antidepressant use by itself. No meaningful difference in the elevated risk was seen among the antidepressant drug classes; however, male patients had a higher risk than female patients 1.
b) SSRIs raise the risk of upper gastrointestinal (GI) bleeding, and this effect is amplified when NSAIDs or low-dose aspirin are used at the same time. Hospitalizations for upper GI bleeding were examined among 26,005 users of antidepressant medications and compared with the number of hospitalizations in patients who did not receive antidepressant prescriptions. The number of upper GI bleeding episodes was 3.6 times greater than expected. Using an SSRI together with NSAIDs or low-dose aspirin raised the risk to 12.2 and 5.2 times, respectively. The results of this study show an elevated risk of upper GI bleeding while SSRIs are being used. Using SSRIs together with NSAIDs or low-dose aspirin raised the risk still further 5.
c) Two metaanalyses examining cases of upper GI bleeding attributable to SSRIs, NSAIDs, and their combination found that SSRIs raised the risk by 1.73 6 to 2.36 times 7, NSAIDs by 2.55 times 6, and the combination of SSRIs and NSAIDs by 4.02 6 to 6.33 times 7.
d) The release of serotonin from platelets plays an important role in maintaining hemostasis. Case-control and cohort studies have demonstrated that using SSRIs and NSAIDs together has been linked to an increased risk of bleeding 8.
Common questions
Can I take Aspirin and Sertraline together?
Combining sertraline and aspirin adds up to a higher bleeding risk, especially in the stomach. Keep taking both as prescribed, watch for bruising or bleeding, and ask your pharmacist or doctor about safer pain options or stomach protection. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Aspirin and Sertraline interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Aspirin and Sertraline interaction managed?
If you have been prescribed both, keep taking them as directed unless your prescriber tells you otherwise. Your care team can manage this interaction. Watch for bleeding signs: unusual bruising, nosebleeds, pink or red tiny skin spots, black or tarry stools, or vomit that looks like coffee grounds. Report these promptly. Ask about pain options: your team may suggest acetaminophen instead of aspiri… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
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Questions for your pharmacist
- Does my dose of Aspirin or Sertraline need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (8)
- 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
- Product Information: VIMOVO(TM) delayed release oral tablets, naproxen and esomeprazole magnesium delayed release oral tablets. AstraZeneca LPW, Wilmington, DE, 2010. DailyMed
- Product Information: SPRIX(TM) nasal spray, ketorolac tromethamine nasal spray. Roxro Pharma, Inc, Menlo Park, CA, 2009. DailyMed
- 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
- 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. DOI
- 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
- 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. DOI
- Product Information: CELEXA(R) oral tablets, citalopram oral tablets. Allergan USA Inc (per FDA), Madison, NJ, 2023. DailyMed
Keep reading about Sertraline
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