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SSRI and NSAID bleeding risk — GPhC CRA MCQ

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ModerateDrug InteractionsSSRI and NSAID bleeding riskGPhC CRA

A 71-year-old woman takes fluoxetine 20mg daily and asks to buy ibuprofen for shoulder pain. She has a history of gastric ulcer and takes no PPI. She also takes aspirin 75mg daily after a TIA. What is the most important interaction to flag?

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Correct answer: C — Fluoxetine, aspirin and ibuprofen together increase gastrointestinal bleeding risk

SSRIs, antiplatelets and NSAIDs can each increase bleeding risk, and the combination is particularly concerning with previous ulcer disease. The patient should be advised against OTC ibuprofen and offered safer alternatives or referral. A PPI may reduce but does not remove risk. The key issue is bleeding rather than reduced analgesia.

Reference: BNF NSAID interactions; BNF Fluoxetine