What side effects should be monitored in an 81-year-old patient on sertraline and clopidogrel?

From the Guidelines

The patient on sertraline and clopidogrel should be monitored for bleeding risks, as both medications can increase the risk of bleeding, particularly in older adults 1.

Key Side Effects to Monitor

• Bleeding risks: The patient should be advised about the signs and symptoms of bleeding, and the risk of bleeding should be assessed regularly 1.
• Gastrointestinal bleeding: The patient is at increased risk for GI bleeding due to the combination of clopidogrel and sertraline, and should be treated concomitantly with a PPI if necessary 1.
• Orthostatic hypotension: The patient should be educated about postural hypotension, as decreased baroreceptor sensitivity with age can increase the risk of orthostatic hypotension, instability, and falls with use of antihypertensives, nitrates, and vasodilators 1.

Recommendations

• Regular monitoring of the patient's blood pressure and renal function is recommended, as well as monitoring for signs of bleeding 1.
• The patient should be educated about the risks of bleeding and the importance of reporting any signs or symptoms of bleeding to their healthcare provider 1.
• The use of misoprostol or a PPI should be considered to reduce the risk of GI bleeding, particularly if the patient has a history of GI bleeding or is taking other medications that increase the risk of bleeding 1.

From the FDA Drug Label

The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including sertraline, alone but particularly with concomitant use of other serotonergic drugs Abnormal Bleeding SSRIs and SNRIs, including sertraline, may increase the risk of bleeding events ranging from ecchymoses, hematomas, epistaxis, petechiae, and gastrointestinal hemorrhage to life-threatening hemorrhage. Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, warfarin, and other anticoagulants or other drugs known to affect platelet function may add to this risk Sertraline can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. Common possible side effects in people who take sertraline include: nausea, loss of appetite, diarrhea or indigestion change in sleep habits including increased sleepiness or insomnia increased sweating sexual problems including decreased libido and ejaculation failure tremor or shaking feeling tired or fatigued agitation

The patient on sertraline and clopidogrel should be monitored for:

• Serotonin syndrome: mental status changes, autonomic instability, neuromuscular symptoms, seizures, and/or gastrointestinal symptoms
• Bleeding events: ecchymoses, hematomas, epistaxis, petechiae, gastrointestinal hemorrhage
• Sleepiness or impaired decision-making
• Common side effects: nausea, loss of appetite, diarrhea, change in sleep habits, increased sweating, sexual problems, tremor, feeling tired or fatigued, agitation 2 2 2

From the Research

Monitoring Side Effects in an 81-year-old Patient on Sertraline and Clopidogrel

The patient's age and medication regimen warrant careful monitoring for potential side effects.

• The most frequently reported adverse events in patients aged > or =60 years with major depressive disorder receiving sertraline 50-150 mg/day were dry mouth, headache, diarrhoea, nausea, insomnia, somnolence, constipation, dizziness, sweating, and taste abnormalities 3.
• Elderly patients are at risk of severe hyponatremia when taking SSRIs, such as sertraline 4, 5.
• Clopidogrel can affect the pharmacokinetics of various drugs, and its efficacy can be influenced by other medications, including SSRIs like sertraline 6.
• Rare but potentially severe side effects of sertraline include rectal bleeding and anal pain 7.

Potential Interactions and Complications

• The combination of sertraline and clopidogrel may increase the risk of bleeding due to the antiplatelet effects of clopidogrel and the potential of sertraline to displace warfarin from plasma proteins 7.
• Healthcare providers should exercise caution when prescribing SSRIs, considering the patient's comorbidities and the potential need for regular electrolyte monitoring 5.
• The patient's age and medication regimen require careful monitoring for potential side effects, including hyponatremia, bleeding, and other adverse events 3, 4, 6, 5, 7.