Anticoagulant and SSRI Interaction Guideline

Introduction to Rivaroxaban and SSRI Interaction

• The European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy notes that anticoagulants should be used with caution when combined with SSRIs due to potential increased bleeding risk 1

Pharmacokinetics and Pharmacodynamics of Rivaroxaban

• Rivaroxaban is metabolized by enzymes CYP3A4 and CYP2J2 and is also a substrate of P-glycoprotein (P-gp) 2
• Strong CYP3A4 and P-gp inhibitors significantly increase rivaroxaban plasma concentrations and decrease total body clearance 2

SSRI Selection and Monitoring

• Consider the sedation profile of the selected SSRI, as some SSRIs can cause more sedation than others, which may be relevant for fall risk in anticoagulated patients 3

Bleeding Risk Management

• NSAIDs further increase bleeding risk and should be avoided or used with extreme caution 1

Special Considerations

• Avoid triple therapy with antiplatelet agents when possible, and be cautious when prescribing multiple renally cleared medications alongside rivaroxaban, although the specific citation for this is ignored, the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy provides relevant guidance on bleeding risk 1