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Wiley InterScience | ||||||||||||||
  Alimentary Pharmacology & TherapeuticsVolume 27 Issue 1, Pages 31 - 40 Published Online: 5 Oct 2007 Journal compilation © 2010 Blackwell Publishing Ltd
Abstract | References | Full Text: HTML, PDF (Size: 142K) | Related Articles | Citation Tracking  Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs Copyright 2008 The Authors Journal compilation 2008 Blackwell Publishing Ltd ABSTRACT
Background Selective serotonin reuptake inhibitors (SSRIs) have been associated with upper gastrointestinal haemorrhage (UGIH) but the magnitude and characteristics of this reaction and possible interaction with concurrent Non-Steroidal Anti-Inflammatory Drug (NSAID) therapy are unknown. Aim To evaluate systematically the risk of UGIH with SSRIs, including interaction with NSAIDs. Methods We searched PubMED, Science Citation Index, and trial registries for data on SSRIs, NSAIDs and UGIH. We evaluated spontaneous case reports from pharmacovigilance databases. Results Random effects meta-analysis of four observational studies involving 153 000 patients showed an odds ratio of 2.36 (95% CI: 1.44–3.85; P = 0.0006) for SSRI associated UGIH. The odds ratio increased to 6.33 (95% CI: 3.40–11.8; P < 0.00001) with concomitant NSAIDs. In patients aged above 50 years with no UGIH risk factors, the Number-Needed-to-Harm per year is 411 for SSRIs alone, and 106 with concomitant NSAIDs. Analysis of 101 spontaneous reports showed that UGIH occurred after a median of 25 weeks with SSRIs. Around 67% of these patients were on NSAIDs. Conclusions Selective serotonin reuptake inhibitor use, alone and in combination with NSAIDs, substantially increases the risk of UGIH. Clinicians should consider this when managing patients at risk of, or presenting with UGIH. Publication data Submitted 9 July 2007 First decision 30 July 2007 Resubmitted 12 September 2007 Second decision 22 September 2007 Resubmitted 24 September 2007 Third decision 24 September 2007 Resubmitted 25 September 2007 Accepted 26 September 2007 | 
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