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Apixaban NSAID SSRI bleeding — GPhC CRA MCQ

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HardDrug InteractionsApixaban NSAID SSRI bleedingGPhC CRA

A 70-year-old woman taking apixaban 5 mg twice daily and sertraline 100 mg daily requests naproxen for an acutely swollen knee. She has previous gastritis but no current bleeding. What is the most appropriate pharmacy response?

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Correct answer: C — Do not supply naproxen; offer safer analgesia and arrange assessment of the knee

Apixaban, an NSAID and an SSRI all increase bleeding risk; naproxen can also increase apixaban exposure. A proton-pump inhibitor may reduce some upper-gastrointestinal risk but does not neutralise systemic or platelet-related bleeding. The pharmacist should not interrupt anticoagulation or antidepressant therapy independently. Avoiding OTC naproxen, using an appropriate safer analgesic and assessing the acutely swollen joint is the best response.

Reference: Eliquis 5 mg SmPC: https://www.medicines.org.uk/emc/product/2878/smpc