Sertraline and Choline Salicylate: 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 recordCholine Salicylate
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.
Let's talk about taking sertraline (an antidepressant) together with choline salicylate (a salicylate pain reliever, in the same family as aspirin and NSAIDs). Each one can make it a little harder for your blood to clot. Sertraline lowers the amount of a clotting helper called serotonin inside your platelets, and salicylates can irritate the stomach lining. Put together, they raise your risk of bleeding, especially in the stomach and gut.
Watch for things like black or bloody stools, throwing up blood, easy bruising, or nosebleeds that won't stop. The good news is that your care team can manage this by choosing safer pain options or keeping a closer eye on you. Please don't stop either drug on your own, just check in with your pharmacist or doctor.
Effect: Additive bleeding risk (GI and intracranial hemorrhage) with concurrent SSRI (sertraline) and a salicylate/NSAID-class agent (choline salicylate).
Mechanism: Sertraline depletes platelet serotonin, impairing serotonin-mediated platelet aggregation; salicylate adds antiplatelet effect plus direct GI mucosal injury. Pharmacodynamic, additive on hemostasis.
- Direction/magnitude: Increased bleeding risk; magnitude not quantified.
- Onset: Unspecified.
- Evidence: Established.
Management: Monitor for GI bleeds, epistaxis, ecchymosis, especially in elderly or those with ulcer history. Consider acetaminophen, an antidepressant with less serotonin reuptake inhibition, or add gastroprotection (PPI/antiulcer prophylaxis).
What happens
An increased risk of bleeding
Interaction Deep Dive
Exercise caution when NSAIDs and antidepressants, including SSRIs, are taken together, since this combination raises the likelihood of intracranial hemorrhage1 as well as gastrointestinal (GI) bleeding 6. Reported bleeding manifestations have ranged from epistaxis, ecchymosis, hematoma, and petechiae to hemorrhages that are life-threatening 5. In patients 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 with a prior history of GI ulcers. Options to consider include alternative approaches to pain control (eg, acetaminophen), reassessment of the selected antidepressant (that is, favoring agents that produce less serotonin reuptake inhibition), 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
This combination is manageable with the right precautions. Keep taking both exactly as prescribed unless your care team tells you otherwise.
- Your team may choose a different pain reliever such as acetaminophen when appropriate.
- They may review your antidepressant or add a stomach-protecting medicine to lower bleeding risk.
- You may be monitored more closely, especially if you are older or have had stomach ulcers.
Tell your pharmacist or doctor right away if you notice black or bloody stools, vomit that looks like coffee grounds, unusual bruising, or a nosebleed that won't stop.
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 compared with using an antidepressant by itself. No significant difference was found between the various antidepressant drug classes with respect to the elevated risk; however, an increased risk was observed in male patients compared with 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 reviewed among 26,005 users of antidepressant medications and compared with the number of hospitalizations in patients who did not receive prescriptions for antidepressants. The number of upper GI bleeding episodes was 3.6 times higher than expected. Concurrent use of an SSRI 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 using SSRIs. Combining SSRIs with NSAIDs or low-dose aspirin raised the risk even more 5.
c) Two metaanalyses of upper GI bleed events attributed 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 secretion of serotonin from platelets plays an important role in maintaining hemostasis. Case-control and cohort studies have demonstrated that using SSRIs together with NSAIDs has been linked to an increased risk of bleeding 8.
Common questions
Can I take Sertraline and Choline Salicylate together?
Sertraline plus choline salicylate raises your bleeding risk, mainly in the stomach and gut. Don't stop either drug on your own, but ask your pharmacist or doctor about safer pain options or extra stomach protection, and watch for signs of bleeding. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Choline Salicylate 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 Choline Salicylate interaction managed?
This combination is manageable with the right precautions. Keep taking both exactly as prescribed unless your care team tells you otherwise. Your team may choose a different pain reliever such as acetaminophen when appropriate. They may review your antidepressant or add a stomach-protecting medicine to lower bleeding risk. You may be monitored more closely, especially if you are older or have had… 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 Choline Salicylate 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 Choline Salicylate
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