The
SSRIs may increase the risk of upper
gastrointestinal bleeding and the risk appears to be further increased by the concurrent use of
NSAIDs.
The manufacturers of the
SSRIs warn that patients should be cautioned about the
concurrent use of
NSAIDs. Alternatives such as paracetamol (acetaminophen) or less gastrotoxic
NSAIDs such as
ibuprofen may be considered, but if the combination of an SSRI and
NSAID cannot be avoided, prescribing of gastro-protective drugs such as proton pump inhibitors, or
H2-receptor antagonists should be considered, especially in elderly patients or those with a history of
gastrointestinal bleeding.