Sertraline and Droxicam: 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 recordDroxicam
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 droxicam, which is an anti-inflammatory pain reliever (an NSAID). Both of these 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. Droxicam can irritate the stomach lining. Put together, that means a higher 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. The good news is your care team can manage this, so please don't stop either medicine on your own, just talk with your pharmacist or doctor.
Effect: Additive bleeding risk (GI and intracranial hemorrhage) with concurrent SSRI (sertraline) and NSAID (droxicam).
Mechanism: Sertraline depletes platelet serotonin, impairing platelet aggregation; droxicam inhibits COX-mediated platelet function and causes GI mucosal injury. Additive effects on hemostasis. Neither agent's activity depends on prodrug conversion here.
- Direction: Increased bleeding risk (PD interaction).
- Evidence: Established. Severity: Major. Onset: Unspecified.
- Management: Monitor for GI bleed/hemorrhage, particularly in elderly or those with prior ulcers. Consider acetaminophen for pain, an antidepressant with less serotonergic activity, or gastroprotective prophylaxis (eg, PPI).
What happens
An increased risk of bleeding
Interaction Deep Dive
Exercise caution when NSAIDs are combined with antidepressants, SSRIs included, because of a heightened likelihood of intracranial hemorrhage1 and gastrointestinal (GI) bleeding6. Reported bleeding manifestations have ranged from epistaxis, ecchymosis, hematoma, and petechiae to hemorrhages that are life-threatening5. In cases where an SSRI is taken alongside an NSAID, watch the patient carefully for indications of adverse events such as GI bleeds, particularly among elderly individuals and those with prior GI ulcers. Options to weigh include alternative approaches to pain control (for example, acetaminophen), reassessment of the selected antidepressant (that is, choosing agents that exert less serotonin reuptake inhibition), or the addition of antiulcer medication as prophylaxis4.
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 medicines as prescribed unless your prescriber tells you otherwise.
- Your care team may monitor you more closely for bleeding, especially if you are older or have had stomach ulcers.
- They may consider a different pain option such as acetaminophen, review your antidepressant choice, or add a stomach-protecting medicine to lower ulcer risk.
- Call your pharmacist or doctor right away if you notice black or bloody stools, coffee-ground vomit, unusual bruising, or nosebleeds that won't stop.
Bring this up at your next visit so your team can tailor the plan 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, 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 found between the various antidepressant drug classes with respect to the elevated risk; nevertheless, the risk was greater in male patients than in female patients 1.
b) SSRIs raise the likelihood of upper gastrointestinal (GI) bleeding, and this effect is enhanced when NSAIDs or low-dose aspirin are used at the same time. Hospitalizations for upper GI bleeding were identified among 26,005 users of antidepressant medications and compared with the number of hospitalizations among patients who were not prescribed antidepressants. The number of upper GI bleeding episodes was 3.6 times higher than anticipated. Using an SSRI together 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 SSRIs are being used. Concurrent use of SSRIs with NSAIDs or low-dose aspirin raised the risk still more 5.
c) Two metaanalyses examining cases of upper GI bleed attributed 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 preserving hemostasis. Case-control and cohort studies have demonstrated that using SSRIs together with NSAIDs has been linked to a heightened risk of bleeding 8.
Common questions
Can I take Sertraline and Droxicam together?
Taking sertraline with the NSAID droxicam adds up to a higher risk of bleeding, especially in the stomach and gut. Keep taking both as prescribed, watch for bleeding signs, and ask your pharmacist or doctor about safer pain options or stomach protection. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Droxicam 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 Droxicam interaction managed?
This combination is manageable with the right precautions. Keep taking both medicines as prescribed unless your prescriber tells you otherwise. Your care team may monitor you more closely for bleeding, especially if you are older or have had stomach ulcers. They may consider a different pain option such as acetaminophen, review your antidepressant choice, or add a stomach-protecting medicine to lo… 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 Droxicam 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 Droxicam
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