Major
apixaban × sertraline
Direct oral anticoagulants (factor Xa inhibitors)×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
SSRIs deplete platelet serotonin and impair primary hemostasis. Combined with apixaban, the risk of major GI bleeding rises roughly 1.5-fold.
Management
If depression requires treatment, prescribe the SSRI and add a PPI (pantoprazole) if GI bleeding risk factors are present. Alternatives include mirtazapine and agomelatine (minimal serotonergic activity).
Sources
- Lexicomp: Lexicomp Drug Interactions (2024)— Wolters Kluwer Clinical Drug Information, Inc. Lexi-Interact Online, 2024
- Pharmaceutical Press: Stockley's Drug Interactions, 12th edition (2024)— Preston CL (ed.). Stockley's Drug Interactions. 12th ed. London: Pharmaceutical Press; 2024