Sertraline and Aceclofenac: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Sertraline
No brand names on recordAceclofenac
No brand names on record
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.
You're taking sertraline (an antidepressant) and aceclofenac (an anti-inflammatory pain reliever, in the same family as ibuprofen). Both can make bleeding more likely, and together the risk adds up.
Sertraline lowers the amount of a chemical called serotonin in your platelets, which are the cells that help your blood clot. Aceclofenac can irritate the stomach lining. Put together, this raises the chance of problems like stomach bleeding or easy bruising. Watch for warning signs such as black or bloody stools, vomit that looks like coffee grounds, or unusual bruising. Don't stop either medicine on your own. Your care team can manage this safely, so please check in with your pharmacist or doctor.
Effect: Additive bleeding risk (GI hemorrhage, intracranial hemorrhage, epistaxis, ecchymosis, petechiae).
Mechanism: Sertraline (SSRI) depletes platelet serotonin, impairing platelet aggregation; aceclofenac (NSAID) inhibits COX-mediated prostaglandin synthesis and gastric mucosal protection, plus antiplatelet effects. Effects on hemostasis are additive. Neither is a relevant prodrug here.
Evidence: Established. Severity: Major. Onset: Unspecified.
Management:
- Monitor for GI bleeding and bruising, especially in elderly patients or those with prior peptic ulcer disease.
- Consider acetaminophen for pain, an antidepressant with less serotonin reuptake inhibition, or gastroprotection (eg, PPI) if concurrent use continues.
What happens
An increased risk of bleeding
Interaction Deep Dive
Exercise caution when NSAIDs are combined with antidepressants, SSRIs included, because this pairing raises the likelihood of intracranial hemorrhage1 as well as gastrointestinal (GI) bleeding 6. Reported bleeding manifestations range from epistaxis, ecchymosis, hematoma, and petechiae to hemorrhages that are life-threatening 5. If a patient is receiving both an SSRI and an NSAID at the same time, watch carefully for indications of adverse events such as GI bleeds, with particular attention to elderly individuals and those who have previously had GI ulcers. Options to consider include alternative approaches to pain control (for example, acetaminophen), reassessment of the selected antidepressant (that is, favoring agents with weaker serotonin reuptake inhibition), or the addition of antiulcer medication as prophylaxis 4.
Why it happens (mechanism)
Depletion of platelet serotonin by SSRI; additive effects on hemostasis
How to manage this interaction
These two can safely be handled by your care team, but it takes some attention because the bleeding risk adds up.
- Keep taking both as prescribed unless your prescriber tells you otherwise.
- Your team may monitor you more closely, especially if you are older or have had stomach ulcers before.
- They might consider options such as a different pain reliever (for example acetaminophen), reviewing your antidepressant, or adding a stomach-protecting medicine.
- Report right away: black or tarry stools, blood in vomit or stool, coffee-ground vomit, or unusual bruising or bleeding.
Bring this up with your pharmacist or doctor so the plan can be tailored to you.
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, led to a 60% higher risk of intracranial hemorrhage within 30 days of combined use, as compared with using an antidepressant on its own. No meaningful difference in the elevated risk was found among the various antidepressant classes; nevertheless, male patients carried a higher risk than female patients 1.
b) SSRIs raise the likelihood of upper gastrointestinal (GI) bleeding, and this effect is amplified when NSAIDs or low-dose aspirin are used at the same time. Admissions for upper GI bleeding were examined among 26,005 people using antidepressant drugs and compared against the number of admissions in patients who were not prescribed antidepressants. The number of upper GI bleeding events was 3.6 times greater than anticipated. Using an SSRI along with NSAIDs or low-dose aspirin raised the risk to 12.2 and 5.2 times, respectively. The results of this study show a heightened risk of upper GI bleeding while SSRIs are being used. Combining SSRIs with NSAIDs or low-dose aspirin raised the risk still further 5.
c) Two metaanalyses examining upper GI bleed events attributable to SSRIs, NSAIDs, and their combination reported that SSRIs raised the risk by 1.73 6 to 2.36 times 7, NSAIDs by 2.55 times 6, and the SSRI plus NSAID combination by 4.02 6 to 6.33 times 7.
d) Serotonin released from platelets plays a key role in preserving hemostasis. Case-control and cohort investigations have demonstrated that using SSRIs and NSAIDs together has been linked to a greater risk of bleeding 8.
Common questions
Can I take Sertraline and Aceclofenac together?
Taking sertraline with aceclofenac raises your bleeding risk, especially in the stomach. Keep taking both as prescribed, watch for signs of bleeding, and ask your pharmacist or doctor whether a safer pain option or stomach protection makes sense for you. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Aceclofenac 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 Sertraline and Aceclofenac interaction managed?
These two can safely be handled by your care team, but it takes some attention because the bleeding risk adds up. Keep taking both as prescribed unless your prescriber tells you otherwise. Your team may monitor you more closely, especially if you are older or have had stomach ulcers before. They might consider options such as a different pain reliever (for example acetaminophen), reviewing your an… 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Sertraline or Aceclofenac 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. PubMed
- Product Information: CELEXA(R) oral tablets, citalopram oral tablets. Allergan USA Inc (per FDA), Madison, NJ, 2023. DailyMed
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Keep reading about Aceclofenac
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