Clopidogrel with Sertraline Interaction Details
Brand Names Associated with Clopidogrel
- Clopidogrel
- Plavix®
Brand Names Associated with Sertraline
- Sertraline
- Zoloft®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
An increased risk of bleeding
Interaction Summary
Exercise caution when coadministering a SSRI and an antiplatelet agent as this may increase the risk of bleeding events. Concomitant use of sertraline with an antiplatelet may potentiate the risk of bleeding. This may be due to the effect of sertraline on the release of serotonin by platelets. Case-control and cohort studies have shown that the combined use of selective serotonin and norepinephrine reuptake inhibitors (such as sertraline) and antiplatelet agents has been associated with an increased risk of bleeding. Bleeding events reported have included epistaxis, ecchymosis, hematoma, petechiae, and life-threatening hemorrhages. When sertraline and an antiplatelet agent are given concurrently, monitor patient for signs of increased bleeding and caution patients about the increased risk of bleeding .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
When sertraline and an antiplatelet agent are given concurrently, monitor patient for signs of increased bleeding and caution patients about the increased risk of bleeding. Concomitant use of sertraline with an antiplatelet may potentiate the risk of bleeding.
Mechanism Of Interaction
Release of serotonin by platelets; additive effects on hemostasis
Literature Reports
A) In a retrospective study of patients over 50 years of age with the diagnosis of acute myocardial infarction (N=27,058), SSRI use with any antiplatelet therapy significantly increased the risk of bleeding by 1.42-fold compared with aspirin use alone. Therapy with aspirin, clopidogrel, and an SSRI significantly increased risk by 2.35-fold compared with aspirin use alone and by 1.57-fold compared with clopidogrel and aspirin combination therapy .
B) In a systematic review and meta-analysis of 22 observational studies, SSRI use was associated with a significant 1.55 fold increase in risk of upper gastrointestinal bleeding (UGIB). Concomitant use of SSRIs and antiplatelet drugs was associated with a 2.48-fold increase in risk of UGIB (3 studies) .
C) Case reports and epidemiological studies (case-control and cohort studies) have demonstrated an association between the use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Based on data from published observational studies, exposure to SSRIs, particularly in the month before delivery, has been associated with a less than 2-fold increase in the risk of postpartum hemorrhage. Bleeding events related to SSRIs and SNRIs have ranged from ecchymosis, hematoma, epistaxis, and petechiae to life-threatening hemorrhages .
Clopidogrel Overview
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Clopidogrel is used alone or with aspirin to prevent serious or life-threatening problems with the heart and blood vessels in people who have had a stroke, heart attack, or severe chest pain. This includes people who have percutaneous coronary intervention (PCI; angioplasty; a type of heart surgery) that may involve inserting coronary stents (metal tubes surgically placed in clogged blood vessels to improve blood flow) or who have coronary artery bypass grafting (CABG; a type of heart surgery). Clopidogrel is also used to prevent serious or life-threatening problems with the heart and blood vessels in people who have peripheral arterial disease (poor circulation in the blood vessels that supply blood to the legs). Clopidogrel is in a class of medications called antiplatelet medications. It works by preventing platelets (a type of blood cell) from collecting and forming clots that may cause a heart attack or stroke.
Sertraline Overview
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Sertraline is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks), posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). It is also used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Sertraline is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amounts of serotonin, a natural substance in the brain that helps maintain mental balance.
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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:
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.