Selected Anticoagulants (Vitamin K antagonists)/SSRIs; SNRIs Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Your antidepressant may affect how blood cells called platelets work to stop bleeding. For some antidepressant and anticoagulant combinations, when the two medicines are taken together, your body may process your anticoagulant more slowly.
What might happen:
You may experience an increased chance for bleeding including bleeding from your gums, nosebleeds, unusual bruising, or dark stools.
What you should do about this interaction:
Contact your healthcare professionals (e.g. doctor or pharmacist) as soon as possible about taking these two medicines together. If your doctor prescribes these medicines together, you may need to check your bleeding times more often. Let your doctor know right away if you have any signs of bleeding such as bleeding from your gums, nosebleeds, unusual bruising, or dark stools.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
- 1.Prozac (fluoxetine hydrochloride) US prescribing information. Eli Lilly and Company October, 2014.
- 2.Claire RJ, Servis ME, Cram DL Jr. Potential interaction between warfarin sodium and fluoxetine. Am J Psychiatry 1991 Nov;148(11):1604.
- 3.Woolfrey S, Gammack NS, Dewar MS, Brown PJ. Fluoxetine-warfarin interaction. BMJ 1993 Jul 24;307(6898):241.
- 4.Bannister SJ, Houser VP, Hulse JD, Kisicki JC, Rasmussen JG. Evaluation of the potential for interactions of paroxetine with diazepam, cimetidine, warfarin, and digoxin. Acta Psychiatr Scand Suppl 1989;350:102-6.
- 5.Lemberger L, Bergstrom RF, Wolen RL, Farid NA, Enas GG, Aronoff GR. Fluoxetine: clinical pharmacology and physiologic disposition. J Clin Psychiatry 1985 Mar;46(3 Pt 2):14-9.
- 6.Wilner KD, Lazar LD, Apseloff G, Gerber N, Yurkewick L. The effects of sertraline on the pharmacodynamics of warfarin in healthy volunteers. Biol Psychiatry 1991;29:354S.
- 7.Glueck CJ, Khalil Q, Winiarska M, Wang P. Interaction of duloxetine and warfarin causing severe elevation of international normalized ratio. JAMA 2006 Apr 5;295(13):1517-8.
- 8.Celexa (citalopram hydrobromide) US prescribing information. Forest Laboratories Inc. January, 2019.
- 9.Lexapro (escitalopram oxalate) US prescribing information. Forest Pharmaceuticals Inc. January, 2019.
- 10.Paxil (paroxetine hydrochloride) US prescribing information. Apotex Technologies January, 2017.
- 11.Pexeva (paroxetine mesylate) US prescribing information. Noven Therapeutics, LLC December, 2012.
- 12.Zoloft (sertraline) US prescribing information. Pfizer Inc. December, 2017.
- 13.Pristiq (desvenlafaxine succinate) US prescribing information. Wyeth Pharmaceuticals, Inc. February 8, 2018.
- 14.Effexor (venlafaxine hydrochloride) US prescribing information. Wyeth Pharmaceuticals December, 2012.
- 15.de Abajo FJ, Rodriguez LA, Montero D. Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study. BMJ 1999 Oct 23;319(7217):1106-9.
- 16.Dalton SO, Johansen C, Mellemkjaer L, Norgard B, Sorensen HT, Olsen JH. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study. Arch Intern Med 2003 Jan 13;163(1):59-64.
- 17.Luvox (fluvoxamine maleate) US prescribing information. Jazz Pharmaceuticals, Inc. January, 2017.
- 18.Trintellix (vortioxetine) US prescribing information. Takeda Pharmaceuticals America, Inc. April 11, 2017.
- 19.Iwagami M, Tomlinson LA, Mansfield KE, Douglas IJ, Smeeth L, Nitsch D. Gastrointestinal bleeding risk of selective serotonin reuptake inhibitors by level of kidney function: A population-based cohort study. Br J Clin Pharmacol 2018 Sep;84(9):2142-2151.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.