Selective serotonin reuptake inhibitors gastrointestinal

FIGURE 47.1 Suggested algorithm for the use of psychotropic medications in the medically ill child or adolescent. CNS, central nervous system GI, gastrointestinal SSRI, selective serotonin reuptake inhibitor TLA, tricyclic antidepressant. 

Dalton SO, Johansen C, Mellemkjaer L, et al Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding a population-based cohort study. Arch Intern Med 163 59-64, 2003... 

Many of the selective serotonin reuptake inhibitors are well tolerated by breast-fed infants. Fluoxetine has resulted in some reports of gastrointestinal problems, irritability, and insomnia. ... 

A potentially dangerous interaction may occur between fluvoxamine and warfarin. There is a 65% increase in plasma warfarin concentration and a significant prolongation of prothrombin time. The selective serotonin reuptake inhibitors (SSRIs) increase the risk of upper gastrointestinal bleeding, and this effect is potentiated by the concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin. There are anecdotal reports of bleeding disorder with the concomitant use of nicoumalone (a coumarin derivate), ibuprofen, and warfarin. 

Toxicity Adverse effects include insomnia, mood changes, dyskinesias, gastrointestinal distress, and hypotension. Meperidine in combination with selegiline has caused agitation, delirium, and death. Selegiline has been implicated in the serotonin syndrome when used in patients taking selective serotonin reuptake inhibitors (see Chapter 30). 

Since their introduction in the 1980s, selective serotonin reuptake inhibitors (SSRls) such as paroxetine, fluoxetine, and citalopram have enjoyed tremendous clinical and commercial success due to their improved safety profile when compared with first-generation tricyclic antidepressants like imipramine. Nevertheless, they still display several side effects including gastrointestinal distress, anxiety, insomnia, weight gain, and sexual dysfunction. Like other current antidepressants. 

Tata LJ, Fortun PJ, Hubbard RB, SmeethL, Hawkey CJ, Smith CJ, Whitaker HJ, Farrington CP, Card TR, West J. Does concurrent prescription of selective serotonin reuptake inhibitors and non-steroidal anti-inflammatory dnigs substantially increase the risk of upper gastrointestinal h ttdirtg7 Aliment Pharmacol Ther (2005) 22,175-81. 

De Abajo FJ, Rodriguez LAG, Montero D. Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding population based case-control study. BMJ (1999)319,1106-9. 

Targownik LE, Bolton JM, Metge CJ, Leung S, Sareen J. Selective serotonin reuptake inhibitors are associated with a modest increase in the risk of upper gastrointestinal bleeding. Am J Gastroenterol 2009 104(6) 1475-82. 

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