Sertraline and Acemetacin: 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 recordAcemetacin
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've been prescribed sertraline (an antidepressant) and acemetacin (an anti-inflammatory pain reliever, a type of NSAID). Taken together, these two can raise your risk of bleeding. Sertraline lowers the amount of serotonin your platelets use to help form clots, and NSAIDs like acemetacin can irritate the stomach lining. Put together, that means a higher chance of things like stomach bleeding, easy bruising, nosebleeds, or, rarely, more serious bleeding.
This doesn't mean you can't use both. It just means your care team may watch you more closely. Please talk with your pharmacist or doctor before making any changes, and let them know right away if you notice black stools, vomit that looks like coffee grounds, or unusual bruising.
Effect: Additive bleeding risk (GI bleeding, intracranial hemorrhage, epistaxis, ecchymosis, petechiae, hematoma).
Mechanism: SSRIs such as sertraline deplete platelet serotonin, impairing platelet aggregation; acemetacin (NSAID) inhibits platelet COX and causes direct GI mucosal injury. These are additive PD effects on hemostasis. Neither is a prodrug concern here.
Evidence: Established. Severity: Major. Onset unspecified.
Management:
- Monitor for GI bleeding, especially in elderly patients or those with prior peptic ulcer disease.
- Consider acetaminophen for analgesia where appropriate.
- Consider an antidepressant with less serotonin reuptake inhibition.
- Consider gastroprotection (eg, PPI or other antiulcer prophylaxis).
What happens
An increased risk of bleeding
Interaction Deep Dive
Combining NSAIDs with antidepressants, SSRIs among them, warrants caution given the heightened likelihood of intracranial hemorrhage1 and gastrointestinal (GI) bleeding 6. Reported bleeding manifestations have ranged from epistaxis, ecchymosis, hematoma, and petechiae to hemorrhages that are life-threatening 5. In cases where an SSRI is administered together with an NSAID, watch the patient carefully for indications of adverse events such as GI bleeds, particularly in the elderly and in individuals with a prior history of GI ulcers. Alternative approaches to pain control (for example, acetaminophen) may be considered, the selected antidepressant may be reassessed (that is, weighing agents that exert less serotonin reuptake inhibition), or antiulcer medication may be prescribed as prophylaxis 4.
Why it happens (mechanism)
Depletion of platelet serotonin by SSRI; additive effects on hemostasis
How to manage this interaction
The good news is your care team can manage this well. Keep taking both medications as prescribed unless your prescriber tells you otherwise. Here is what a care team commonly does:
- Closer monitoring for signs of bleeding, especially if you are older or have had stomach ulcers.
- Considering a different pain option such as acetaminophen when suitable.
- Reviewing the antidepressant choice, or adding a stomach-protecting medicine (like an antiulcer drug) as prophylaxis.
Ask your pharmacist or doctor which of these fits you best. Report any black or tarry stools, coffee-ground vomit, unusual bruising, or bleeding that won't stop right away.
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 to antidepressant use by itself. No meaningful difference was observed among the antidepressant drug classes with respect to this elevated risk; nevertheless, male patients showed a higher risk than female patients 1.
b) SSRIs raise the likelihood of upper gastrointestinal (GI) bleeding, and this effect is amplified by simultaneous use of NSAIDs or low-dose aspirin. Hospital admissions for upper GI bleeding were identified among 26,005 users of antidepressant drugs and compared to the number of admissions among patients who were not prescribed antidepressants. The number of upper GI bleeding events was 3.6 times higher than anticipated. Concurrent use of an SSRI with NSAIDs or with 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 during SSRI use. Combined use of SSRIs with NSAIDs or low-dose aspirin raised the risk even further 5.
c) Two metaanalyses examining episodes of upper GI bleed 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 combination of SSRIs and NSAIDs by 4.02 6 to 6.33 times 7.
d) The secretion of serotonin by platelets plays an important role in maintaining hemostasis. Case-control and cohort studies have demonstrated that the combined use of SSRIs and NSAIDs has been linked to an increased risk of bleeding 8.
Common questions
Can I take Sertraline and Acemetacin together?
Combining sertraline with the NSAID acemetacin raises your bleeding risk, especially in the stomach; keep taking both as prescribed but ask your pharmacist or doctor about safer pain options or stomach protection, and report any signs of bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Acemetacin 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 Acemetacin interaction managed?
The good news is your care team can manage this well. Keep taking both medications as prescribed unless your prescriber tells you otherwise. Here is what a care team commonly does: Closer monitoring for signs of bleeding, especially if you are older or have had stomach ulcers. Considering a different pain option such as acetaminophen when suitable. Reviewing the antidepressant choice, or adding a… 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 Acemetacin 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
Keep reading about Sertraline
Keep reading about Acemetacin
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