Caution About Using Fluoxetine or Fluvoxamine With Warfarin

November 2014

You'll hear that combining antithrombotics with SSRI or SNRI antidepressants has an additive effect on bleeding.

SSRIs and SNRIs alone can increase bleeding risk...probably by inhibiting serotonin reuptake into platelets.

One more A fib patient per year will have a major bleed for every 100 using warfarin plus an SSRI or SNRI...compared to warfarin alone.

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Table of Contents

Anticoagulants Suggest Xarelto Over Pradaxa for Treating VTE
Acute Pain Recommend Acetaminophen PLUS an NSAID Instead of an Opioid for Acute Pain
COPD Don't Be Surprised if Some Stable COPD Patients Stop Inhaled Steroids
Migraine Suggest Prophylaxis for Kids or Teens With at Least 4 Migraines per Month
Renal & Urology Suggest Checking Serum Sodium Before Patients Start Nocdurna for Nocturia
NSAIDs Recommend NOT Going Over 100 mg/day of Diclofenac Orally or Rectally
Oral Health Don't Use Chlorhexidine for Oral Mucositis
Geriatrics Reassess if Dementia Meds Are Needed Since Many Patients DON'T Benefit
Antithrombotics Caution About Using Fluoxetine or Fluvoxamine With Warfarin
Dyslipidemia Expect Most Patients to Have GI Side Effects With Juxtapid
Antiepileptics Watch for Contraception Interactions with Aptiom
Practice Learn the Latest About Limiting Exposure to Ebola
Opioids Warn Buprenorphine May Cause Withdrawal if Patients Have Opioids in Their System