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Abstract

Objective:

To report a case of spontaneous bruising with concomitant use of nonsteroidal antiinflammatory drugs (NSAIDs) and citalopram.

Case Summary:

A 34-year-old white woman with a history of chronic thrombocytopenia (baseline platelet count 120–130 × 10³/μL) presented to the emergency department (ED) after noticing an increase in bruising on her upper and lower extremities. When the patient was interviewed, it was found that her dose of citalopram had been recently increased from 20 to 40 mg/day and she had started ibuprofen (dose unknown) on her own to manage rib pain approximately 1 month after the citalopram dosage increase. The patient was advised to discontinue ibuprofen and was discharged. Shortly thereafter, she was started on oxaprozin 600 mg twice daily for management of trochanteric bursitis. She returned to the ED stating that bruising occurred 1 week after she was given oxaprozin. At this visit, the patient was told to discontinue oxaprozin and naproxen 440 mg twice daily was prescribed. One week later, the patient again returned to the ED with complaints of spontaneous bruising. At this point citalopram and naproxen were discontinued and she was started on acetaminophen (dose not documented) and buspirone 10 mg twice daily. No other episodes of ecchymosis have occurred in the 8 months since this change to her drug regimen.

Discussion:

Medications that increase the risk of bleeding should be carefully administered in patients who have a low platelet count. This patient experienced bruising when her dose of citalopram was increased and an increase in bruising when she combined an NSAID with citalopram. Selective serotonin reuptake inhibitors (SSRIs) may increase antiplatelet activity of NSAIDs and could therefore increase the risk of bruising. Use of the Horn Drug Interaction Probability Scale indicated a possible interaction with concomitant use of NSAIDs and citalopram.

Conclusions:

Patients who experience NSAID- and/or SSRI-related bruising should consult their providers and alternative treatments should be considered.

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References

Oyesanmi

Kunkel

Monti

Field

. Hematologic side effects of psychotropics. Psychosomatics 1999; 40: 414–20. doi: 10.1016/S0033–3182(99)71206–5

Schafer

. Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis. J Clin Pharmacol 1995; 35: 209–19. doi: 10.1016/S0149–2918(99)80020–4

Dalton

Johansen

Mellemkjoer

. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding. Arch Intern Med 2003; 163: 59–64. doi: 10.1001/archinte.163.1.59

Krasowska

Szymanek

Schwartz

. Cutaneous effects of the most commonly used antidepressant medication, the selective serotonin reuptake inhibitors. J Am Acad Dermatol 2006; 56: 848–53. doi: 10.1016/j.jaad.2006.10.020

Reeves

Wise

Cox

. SSRIs and the risk of abnormal bleeding. J Psychosoc Nurs Ment Health Serv 2007; 45: 15–21.

Clinical pharmacology. Tampa, FL: Gold Standard, Inc., 2006. http://cp.gsm.com (accessed 2012 Mar 7).

Horn

Hansten

Chan

. Proposal for a new tool to evaluate drug interaction cases. Ann Pharmacother 2007; 41: 674–80. doi: 10.1345/aph.1H423

McCloskey

Postolache

Vittone

. Selective serotonin reuptake inhibitors (SSRIs): Measurement of effect on platelet function. Transl Res 2008;151:168–168. doi: 10.1016/j.trsl.2007.10.004

Layton

Clark

DWJ

Pearce

. Is there an association between selective serotonin reuptake inhibitors and risk of abnormal bleeding? Eur J Clin Pharmacol 2001; 57: 167–76. doi: 10.1007/S002280100263

10.

Sanchez

Hyttel

. Comparison of the effects of antidepressants and their metabolites on reuptake of biogenic amines and on receptor binding. Cell Mol Neurobiol 1999; 19: 467–89. doi: 10.1023/A:1006986824213

11.

Package insert. Celexa (citalopram). St. Louis, MO: Forest Laboratories, August 2011.

Risk of Spontaneous Bruising with Concomitant Use of Nonsteroidal Antiinflammatory Drugs and Citalopram