Moderate
Probable
الوصف
Aspirin combined with fluoxetine increases GI hemorrhage risk through synergistic platelet impairment and CYP2C9-mediated interactions.
الآلية
Fluoxetine depletes platelet serotonin and inhibits COX-2 at higher concentrations; aspirin inhibits COX-1. Both reduce platelet aggregation through different but additive mechanisms.
الأهمية السريرية
Epidemiological studies document a 3- to 5-fold increase in upper GI bleed risk with combined antiplatelet + SSRI.
التدبير
Co-prescribe a PPI; counsel patients on GI bleeding signs; use the lowest effective dose of each agent.