Sertraline and Amtolmetin Guacil: 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 recordAmtolmetin Guacil
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) along with amtolmetin guacil (an anti-inflammatory pain medicine, an NSAID). On their own, each can make bleeding a little more likely. Sertraline makes your platelets (the cells that help blood clot) less sticky, and NSAIDs can irritate the stomach lining. Used together, they can raise the chance of bleeding, especially in the stomach or gut.
Watch for warning signs like black or bloody stools, vomit that looks like coffee grounds, easy bruising, or nosebleeds. This is manageable. Please don't stop either medicine on your own, just talk with your pharmacist or doctor so they can keep you safe.
Effect: Additive bleeding risk (GI bleeding, intracranial hemorrhage) with concurrent SSRI (sertraline) and NSAID (amtolmetin guacil).
Mechanism: Sertraline inhibits platelet serotonin reuptake, depleting platelet serotonin and impairing hemostasis; the NSAID adds antiplatelet effects plus direct GI mucosal injury. Pharmacodynamic, not a prodrug/enzyme issue.
Evidence: Established. Severity: Major. Onset unspecified.
Management:
- Monitor for GI bleed signs (melena, hematemesis), bruising, epistaxis, petechiae.
- Higher vigilance in elderly and those with prior ulcers.
- Consider acetaminophen alternative, an antidepressant with less serotonin reuptake inhibition, or gastroprotection (PPI/antiulcer prophylaxis).
What happens
An increased risk of bleeding
Interaction Deep Dive
Exercise caution when NSAIDs and antidepressants, such as SSRIs, are used together, since this combination raises the likelihood of intracranial hemorrhage1 and gastrointestinal (GI) bleeding 6. Reported bleeding manifestations have ranged from epistaxis, ecchymosis, hematoma, and petechiae to life-threatening hemorrhages 5. If an SSRI and an NSAID are administered at the same time, monitor the patient carefully for adverse events, including GI bleeds, with particular attention to elderly individuals and those with a prior history of GI ulcers. Alternative approaches to pain control may be considered (for example, acetaminophen), the selected antidepressant may be reassessed (that is, favoring agents with weaker serotonin reuptake inhibition), or prophylactic treatment with antiulcer medications may be prescribed 4.
Why it happens (mechanism)
Depletion of platelet serotonin by SSRI; additive effects on hemostasis
How to manage this interaction
This combination is used sometimes, but your care team will want to keep an eye on you.
- Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise.
- Your team may monitor you more closely for bleeding, especially if you're older or have had stomach ulcers.
- They might discuss options such as a different pain reliever (for example, acetaminophen), reviewing your antidepressant, or adding a stomach-protecting medicine.
Call your pharmacist or prescriber right away if you notice black or bloody stools, coffee-ground vomit, unusual bruising, or frequent nosebleeds.
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 significant difference was seen among the various antidepressant drug classes with respect to this elevated risk; however, male patients had a greater 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 reviewed among 26,005 people using antidepressant medications and compared against the number of admissions in patients who did not have prescriptions for antidepressants. The number of upper GI bleeding events was 3.6 times higher 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. Concurrent use of SSRIs with NSAIDs or low-dose aspirin raised the risk still further 5.
c) Two meta-analyses of upper GI bleed events attributable to SSRIs, NSAIDs, and their combination determined 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 from platelets plays an important role in sustaining hemostasis. Case-control and cohort studies have demonstrated that the combined use of SSRIs and NSAIDs has been linked to a heightened risk of bleeding 8.
Common questions
Can I take Sertraline and Amtolmetin Guacil together?
Taking sertraline with the NSAID amtolmetin guacil raises the risk of bleeding, especially in the stomach and gut. Keep both as prescribed, watch for bleeding signs, and ask your pharmacist or doctor about monitoring or safer options. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Amtolmetin Guacil 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 Amtolmetin Guacil interaction managed?
This combination is used sometimes, but your care team will want to keep an eye on you. Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise. Your team may monitor you more closely for bleeding, especially if you're older or have had stomach ulcers. They might discuss options such as a different pain reliever (for example, acetaminophen), reviewing your antidepressan… 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 Amtolmetin Guacil 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 Amtolmetin Guacil
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