Yuet Wei Cheng, Derasari Dhvani, Sivoravong Jon, Mason David, Jann Michael
J Am Osteopath Assoc. 2019 Feb 1;119(2):102-111. doi: 10.7556/jaoa.2019.016.
Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications in the United States. Although SSRIs are highly tolerable relative to other antidepressants, they are associated with a number of adverse effects, including increased gastrointestinal tract bleeding and intracranial bleeding. Mechanisms include increased gastric acid secretion and inhibition of serotonin entrance into platelets. Patients with other bleeding risk factors, such as warfarin, clopidogrel, or aspirin use, may be at heightened risk of these adverse effects. The purpose of this article is to review the incidence of gastrointestinal tract bleeding or intracranial bleeding associated with concomitant SSRI use, the proposed mechanisms of, and the potential pharmacokinetic/pharmacodynamic interactions with anticoagulants and antiplatelets. Given the prevalence of SSRI use in the ambulatory setting, osteopathic physicians should be aware of potential drug-drug interactions and the clinical implications of SSRI-associated bleeding risk.
选择性5-羟色胺再摄取抑制剂（SSRIs）是美国最常开具的药物之一。尽管相对于其他抗抑郁药，SSRIs具有较高的耐受性，但它们会引发多种不良反应，包括胃肠道出血和颅内出血增加。其机制包括胃酸分泌增加以及5-羟色胺进入血小板受到抑制。患有其他出血风险因素的患者，如使用华法林、氯吡格雷或阿司匹林，可能会面临更高的这些不良反应风险。本文旨在综述与同时使用SSRI相关的胃肠道出血或颅内出血的发生率、其潜在机制以及与抗凝剂和抗血小板药物潜在的药代动力学/药效学相互作用。鉴于在门诊环境中使用SSRI的普遍性，骨科医生应了解潜在的药物相互作用以及与SSRI相关的出血风险的临床意义。
