Sertraline and Morniflumate: 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 recordMorniflumate
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 morniflumate (an anti-inflammatory pain medicine, an NSAID). Taken together, they can raise your risk of bleeding. Here's why: sertraline lowers the amount of a chemical called serotonin inside your platelets, which are the cells that help your blood clot. NSAIDs like morniflumate also make bleeding easier, especially in the stomach. Put them together and the effect adds up.
This doesn't mean something bad will happen, but it's worth watching. Signs to report include stomach pain, black or bloody stools, easy bruising, or nosebleeds. Please don't stop either medicine on your own. Your care team can manage this safely, so bring it up with your pharmacist or doctor.
Effect: Additive bleeding risk (GI bleeding, intracranial hemorrhage, epistaxis, ecchymosis, petechiae).
Mechanism: Sertraline (SSRI) depletes platelet serotonin, impairing serotonin-mediated platelet aggregation; morniflumate (NSAID) adds antiplatelet effect plus direct GI mucosal injury. Additive PD effect on hemostasis. Neither is a relevant prodrug here.
Evidence: Established. Severity: Major. Onset: Unspecified.
Management:
- Monitor for GI bleeding and other bleeding signs, especially in elderly patients or those with prior GI ulcers.
- Consider acetaminophen for pain instead of an NSAID.
- Consider an antidepressant with less serotonin reuptake inhibition.
- Consider gastroprotection (eg, antiulcer prophylaxis) if the combination continues.
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 range from epistaxis, ecchymosis, hematoma, and petechiae to hemorrhages that are life-threatening 5. During concurrent administration of an SSRI and an NSAID, watch the patient carefully for indications of adverse events such as GI bleeds, particularly in the elderly and in those with a prior history of GI ulcers. Options to consider include alternative pain management approaches (for example, acetaminophen), reassessment of the selected antidepressant (that is, favoring agents with weaker serotonin reuptake inhibition), or the use of antiulcer medications as prophylaxis 4.
Why it happens (mechanism)
Depletion of platelet serotonin by SSRI; additive effects on hemostasis
How to manage this interaction
This combination is manageable, and your care team has several options. Keep taking both medicines as prescribed unless your prescriber tells you otherwise.
- Watch for bleeding: report stomach pain, black or bloody stools, vomiting that looks like coffee grounds, unusual bruising, or frequent nosebleeds.
- Your team may monitor you more closely, especially if you are older or have a history of stomach ulcers.
- They may consider a different pain option such as acetaminophen, review your antidepressant choice, or add a stomach-protecting medicine.
Bring this up at your next visit 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, produced a 60% higher risk of intracranial hemorrhage within 30 days of combined use when compared with using an antidepressant by itself. No meaningful difference was observed among the antidepressant classes with respect to this elevated risk; nevertheless, male patients had a greater risk than female patients 1.
b) SSRIs raise the risk of upper gastrointestinal (GI) bleeding, and this effect is intensified by simultaneous use of NSAIDs or low-dose aspirin. 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 antidepressant prescriptions. The number of upper GI bleeding events was 3.6 times greater than anticipated. 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 a heightened risk of upper GI bleeding while taking SSRIs. Combining SSRIs with NSAIDs or low-dose aspirin increased the risk still further 5.
c) Two metaanalyses examining cases of upper GI bleed related 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 the concurrent use of SSRIs and NSAIDs has been linked to a heightened bleeding risk 8.
Common questions
Can I take Sertraline and Morniflumate together?
Combining sertraline with the NSAID morniflumate adds up to a higher bleeding risk, especially in the stomach. Keep taking both as prescribed, watch for bleeding signs, 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 Morniflumate 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 Morniflumate interaction managed?
This combination is manageable, and your care team has several options. Keep taking both medicines as prescribed unless your prescriber tells you otherwise. Watch for bleeding: report stomach pain, black or bloody stools, vomiting that looks like coffee grounds, unusual bruising, or frequent nosebleeds. Your team may monitor you more closely, especially if you are older or have a history of stomac… 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 Morniflumate 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 Morniflumate
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