From the FDA Drug Label
Patients should be cautioned about the concomitant use of fluoxetine and NSAIDs, aspirin, warfarin, or other drugs that affect coagulation since combined use of psychotropic drugs that interfere with serotonin reuptake and these agents have been associated with an increased risk of bleeding
- Key Points:
- Aspirin (ASA) and fluoxetine may increase the risk of bleeding when taken together
- Patients should be cautioned about this potential risk
- Clinical Decision: It is not recommended to take Aspirin (ASA) and fluoxetine together without consulting a physician, due to the potential increased risk of bleeding 1
From the Research
It is generally safe for most people to take aspirin (ASA) and fluoxetine together, but you should always consult with your healthcare provider before combining these medications. These medications don't have a major interaction that would make their combination absolutely contraindicated. However, both medications can increase the risk of bleeding when taken individually, and this risk may be higher when they are used together. Aspirin reduces platelet aggregation while fluoxetine (an SSRI antidepressant) can affect serotonin uptake in platelets, potentially leading to prolonged bleeding time 2.
Key Considerations
- If you're prescribed both medications, watch for signs of increased bleeding such as easy bruising, nosebleeds, bleeding gums, or dark stools.
- People with a history of bleeding disorders, gastrointestinal ulcers, or those taking other blood thinners should be particularly cautious.
- Your doctor may recommend taking aspirin with food to reduce stomach irritation and might monitor you more closely if you're on both medications long-term.
- A recent study found that the concurrent use of NSAIDs and SSRIs increases the risk of GI bleeding, with an odds ratio of 2.14 (95% CI 1.52-3.02, p < 0.001) 3.
- Another study found that anticoagulants, low-dose aspirin, NSAIDs, and other non-aspirin-APA drugs are associated with increased risk of upper and lower gastrointestinal bleeding, with anticoagulants appearing to be the strongest risk factor for gastrointestinal bleeding 4.
Monitoring and Precautions
- Patients taking both aspirin and fluoxetine should be monitored closely for signs of bleeding, particularly if they have a history of bleeding disorders or are taking other medications that increase the risk of bleeding.
- The use of proton pump inhibitors may be recommended to reduce the risk of upper gastrointestinal bleeding 4, 5.
- Never adjust your medication regimen without professional medical advice, as the risk of bleeding can be significant and may require careful management.