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Risk of serious upper gastrointestinal events with concurrent use of NSAIDs and SSRIs: a case-control study in the general population

  • Pharmacoepidemiology and Prescription
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Abstract

Objectives

To study the risk of serious upper gastrointestinal (GI) events associated with the concurrent use of selective serotonin re-uptake inhibitors (SSRIs) and different types of non-steroidal anti-inflammatory drugs (NSAIDs).

Methods

This was a nationwide, register-based matched case-control study on non-institutionalized residents of Finland during the period 2000–2004. Patient-cases with serious upper GI events (n = 9191) were drawn from the Hospital Discharge Register, and individually matched controls (n = 41,780) were drawn from the Population Register. Logistic regression was applied in the data analysis, and adjustments were made for various co-morbidities and the use of other drugs associated with the risk of serious upper GI event.

Results

The adjusted odds ratio (AOR) of serious upper GI events for SSRI use compared to non-use of SSRIs or NSAIDs was 1.30 [95% confidence interval (95%CI: 1.13–1.50)], and the AOR for concurrent SSRI and NSAID use compared to the non-use of either drug was 4.19 (95%CI: 3.30–5.31). The AOR of upper GI events for the concurrent use of SSRIs with NSAIDs compared to patients using NSAIDs only was 1.57 (95%CI: 1.24–1.99). The respective AOR for traditional, non-selective NSAIDs was 1.77 (95%CI: 1.31–2.38), for semi-selective NSAIDs (nimesulide, nabumetone, meloxicam, and etodolac) 1.30 (95%CI: 0.76–2.24) and for COX-2 selective NSAIDs 1.33 (95%CI: 0.70–2.50).

Conclusions

The concurrent use of SSRIs and NSAIDs is associated with a moderate excess relative risk of a serious upper GI event when compared with NSAID use alone.

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Acknowledgements

We thank Hilkka Ruuska and Kristiina Tyrkkö, the Social Insurance Institution, for their data management skills.

Author information

Authors and Affiliations

  1. Graduate School of Clinical Drug Research, c/o Clinical Pharmacology, P.B. 340, 00290, Helsinki, Finland

    Arja Helin-Salmivaara

  2. 4Pharma Ltd, Lemminkäisenkatu 1, 05200, Turku, Finland

    Teppo Huttunen

  3. Department of Emergency, Turku University Hospital, Turku, Finland

    Juha M. Grönroos

  4. Department of Surgery, University of Turku, P.B. 52, 20521, Turku, Finland

    Juha M. Grönroos

  5. Research Department, Social Insurance Institution, P.B. 450, 00101, Helsinki, Finland

    Timo Klaukka

  6. Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Itäinen Pitkäkatu 4, 20014, Turku, Finland

    Risto Huupponen

  7. Clinical Pharmacology, Tykslab, Turku University Hospital and Health Care District of Southwest Finland, 02501, Turku, Finland

    Risto Huupponen

Authors
  1. Arja Helin-Salmivaara
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  2. Teppo Huttunen
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  3. Juha M. Grönroos
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  4. Timo Klaukka
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  5. Risto Huupponen
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Corresponding author

Correspondence to Arja Helin-Salmivaara.

Additional information

Financial disclosure: Timo Klaukka has been employed by the financier and organizer of the national sickness insurance scheme, including drug reimbursements. No other conflict of interests has been announced.

Funding: The Centre for Pharmacotherapy Development funded the statistical analysis. The funding source was not involved in the analysis.

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Helin-Salmivaara, A., Huttunen, T., Grönroos, J.M. et al. Risk of serious upper gastrointestinal events with concurrent use of NSAIDs and SSRIs: a case-control study in the general population. Eur J Clin Pharmacol 63, 403–408 (2007). https://doi.org/10.1007/s00228-007-0263-y

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  • DOI: https://doi.org/10.1007/s00228-007-0263-y

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