Sertraline and Selexipag: 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 recordSelexipag
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.
Taking sertraline with selexipag (Uptravi) can make it a little easier to bleed or bruise. Sertraline is an antidepressant that lowers the amount of serotonin your platelets use to help form clots. Selexipag also affects platelets. Put them together and your blood may clot a bit less easily.
This is mostly a theoretical concern based on how these drugs work, but it is worth watching for. Signs to notice include nosebleeds, easy bruising, or bleeding that is slow to stop. Please don't stop either medicine on your own. Your care team can manage this by keeping an eye on you, and you can help by telling them about any unusual bleeding.
Effect: Additive pharmacodynamic bleeding risk when sertraline is combined with selexipag.
- Mechanism: Sertraline depletes platelet serotonin (via inhibition of platelet 5-HT uptake), impairing serotonin-mediated platelet aggregation; additive to selexipag's antiplatelet-type effects on hemostasis. Neither agent's activity here depends on prodrug conversion relevant to this interaction.
- Direction/magnitude: Increased bleeding risk; magnitude not quantified.
- Onset: Unspecified.
- Evidence: Theoretical, though SSRI/antiplatelet epidemiologic data support the class effect.
- Management: Monitor for epistaxis, ecchymosis, hematoma, petechiae, and overt hemorrhage. Counsel on bleeding signs; escalate if significant bleeding occurs.
What happens
An increased risk of bleeding
Interaction Deep Dive
Caution is warranted when a SSRI is given together with an antiplatelet drug, since this combination can raise the likelihood of bleeding events32. Using sertraline alongside an antiplatelet may heighten bleeding risk, an effect that may stem from sertraline's influence on serotonin release by platelets. Both case-control and cohort investigations have linked the joint use of selective serotonin and norepinephrine reuptake inhibitors (for example, sertraline) with antiplatelet agents to a greater bleeding risk. Reported bleeding events have encompassed epistaxis, ecchymosis, hematoma, petechiae, and hemorrhages that are life-threatening. If sertraline and an antiplatelet agent are administered concurrently, watch the patient for indications of heightened bleeding and advise patients regarding the elevated bleeding risk1.
Why it happens (mechanism)
Release of serotonin by platelets; additive effects on hemostasis
How to manage this interaction
Both drugs can be used together, but your care team will watch you a bit more closely for bleeding.
- Keep taking both as prescribed unless your prescriber tells you otherwise.
- Watch for: nosebleeds, easy bruising, small red spots on the skin, blood in urine or stool, or cuts that keep bleeding.
- Report any unusual or heavy bleeding to your pharmacist or doctor promptly, and seek urgent care for severe bleeding.
- Mention other blood thinners, aspirin, or NSAIDs (like ibuprofen) you take, since these can add to the risk.
Your team can adjust and individualize your plan and monitoring to keep this manageable.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
3 reports — tap to read
a) A retrospective study involving patients older than 50 years who were diagnosed with acute myocardial infarction (N=27,058) found that combining an SSRI with any antiplatelet regimen raised bleeding risk significantly, by 1.42-fold, relative to aspirin alone. The combination of aspirin, clopidogrel, and an SSRI produced a significant increase in risk of 2.35-fold compared with aspirin alone and 1.57-fold compared with the combination of clopidogrel and aspirin 2.
b) A systematic review and meta-analysis comprising 22 observational studies found that SSRI use carried a significant 1.55-fold increase in the risk of upper gastrointestinal bleeding (UGIB). Using SSRIs together with antiplatelet drugs was linked to a 2.48-fold increase in the risk of UGIB (3 studies) 3.
c) Case reports along with epidemiological studies (both case-control and cohort designs) have shown a link between the use of agents that block serotonin reuptake and the incidence of gastrointestinal bleeding. According to data from published observational studies, exposure to SSRIs, especially during the month preceding delivery, has been linked to a less than 2-fold rise in the risk of postpartum hemorrhage. Bleeding events associated with SSRIs and SNRIs have ranged from ecchymosis, hematoma, epistaxis, and petechiae to life-threatening hemorrhages 1.
Common questions
Can I take Sertraline and Selexipag together?
Sertraline and selexipag together may raise your bleeding risk, so keep taking both as prescribed but watch for bruising or bleeding and tell your care team about anything unusual. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Selexipag 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 Selexipag interaction managed?
Both drugs can be used together, but your care team will watch you a bit more closely for bleeding. Keep taking both as prescribed unless your prescriber tells you otherwise. Watch for: nosebleeds, easy bruising, small red spots on the skin, blood in urine or stool, or cuts that keep bleeding. Report any unusual or heavy bleeding to your pharmacist or doctor promptly, and seek urgent care for seve… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
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 Selexipag 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 (3)
- Product Information: ZOLOFT oral tablets, oral solution, sertraline hydrochloride oral tablets, oral solution. Viatris Specialty LLC (per FDA), Morgantown, WV, 2023. DailyMed
- Labos C, Dasgupta K, Nedjar H, et al: Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. CMAJ 2011; 183(16):1835-1843. PubMed
- Jiang HY, Chen HZ, Hu XJ, et al: Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2015; 13(1):42-50. PubMed
Keep reading about Sertraline
Keep reading about Selexipag
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