Sertraline and Tenoxicam: 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 recordTenoxicam
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.
Taking sertraline and tenoxicam together can raise your risk of bleeding. Sertraline is an SSRI antidepressant. Besides lifting mood, it uses up some of the serotonin that your platelets (the cells that help you clot) need to stop bleeding. Tenoxicam is an anti-inflammatory pain medicine (an NSAID) that can also irritate the stomach lining and make bleeding easier. Put together, they add up.
Watch for signs like a stomachache, black or bloody stools, easy bruising, nosebleeds, or vomit that looks like coffee grounds. Please don't stop either medicine on your own. Your pharmacist or doctor can manage this well, so let them know you take both.
Effect: Additive bleeding risk (GI and intracranial hemorrhage) with concurrent SSRI (sertraline) and NSAID (tenoxicam).
Mechanism: Sertraline depletes platelet serotonin, impairing platelet-mediated hemostasis; tenoxicam adds antiplatelet effect plus direct GI mucosal injury. Additive PD interaction (neither is a relevant prodrug here).
Evidence: Established. Severity: Major. Onset unspecified.
- Monitor for GI bleeding, epistaxis, ecchymosis, hematoma, petechiae.
- Highest risk in elderly and patients with prior PUD/GI bleed.
- Consider acetaminophen for pain, an antidepressant with less serotonin reuptake inhibition, or gastroprotection (e.g., PPI) if the combination continues.
What happens
An increased risk of bleeding
Interaction Deep Dive
Combining NSAIDs with antidepressants, SSRIs included, warrants caution because it heightens the likelihood of intracranial hemorrhage1 as well as gastrointestinal (GI) bleeding6. Reported bleeding manifestations range from epistaxis, ecchymosis, hematoma, and petechiae to hemorrhages that are life-threatening5. Patients receiving an SSRI together with an NSAID should be watched carefully for indications of adverse events such as GI bleeds, with particular attention to the elderly and individuals who have previously had GI ulcers. Alternative approaches to pain control (for example, acetaminophen) may be considered, the selected antidepressant can be reassessed (that is, opting for agents that produce less serotonin reuptake inhibition), or antiulcer medications can be prescribed as prophylaxis4.
Why it happens (mechanism)
Depletion of platelet serotonin by SSRI; additive effects on hemostasis
How to manage this interaction
Keep taking both as prescribed unless your care team tells you otherwise. Because this combination raises bleeding risk, your team may take steps to keep you safe.
- They may monitor you more closely for signs of bleeding, especially if you are older or have had stomach ulcers or GI bleeds.
- They may consider a different pain option such as acetaminophen.
- They may review your antidepressant choice, or add a stomach-protecting medicine (such as an antiulcer drug).
Call your pharmacist or doctor promptly if you notice black or bloody stools, vomiting blood or coffee-ground material, unusual bruising, or nosebleeds. Seek urgent care for a severe headache.
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 meaningful difference was found among the antidepressant drug classes with respect to the elevated risk; nevertheless, the risk was higher in male patients than in 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 examined among 26,005 people using antidepressant medications and compared with the number of admissions in patients who did not have prescriptions for antidepressants. The number of upper GI bleeding events was 3.6 times greater 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 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 cases of upper GI bleeding attributable to SSRIs, NSAIDs, and their combination reported 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 by platelets plays a key role in sustaining hemostasis. Case-control and cohort studies have demonstrated that using SSRIs and NSAIDs together has been linked to a greater risk of bleeding 8.
Common questions
Can I take Sertraline and Tenoxicam together?
Sertraline and tenoxicam together add 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 is right for you. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Tenoxicam 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 Tenoxicam interaction managed?
Keep taking both as prescribed unless your care team tells you otherwise. Because this combination raises bleeding risk, your team may take steps to keep you safe. They may monitor you more closely for signs of bleeding, especially if you are older or have had stomach ulcers or GI bleeds. They may consider a different pain option such as acetaminophen. They may review your antidepressant choice, o… 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 Tenoxicam 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 Tenoxicam
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