Moderate
clopidogrel × sertraline
Antiplatelet agents – P2Y12 receptor inhibitors×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Two effects: 1) clopidogrel blocks aggregation at the P2Y12 receptor while sertraline impairs primary hemostasis by inhibiting platelet serotonin reuptake; 2) sertraline weakly inhibits CYP2C19 – clopidogrel activation is slightly reduced.
Management
Watch for bleeding signs. With elevated GI risk, add a PPI (pantoprazole, not omeprazole). Antidepressant alternatives with minimal platelet effects include mirtazapine and bupropion.
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