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A different approach to ecchymosis due to paroxetine

Year 2022, Volume: 47 Issue: 3, 1378 - 1380, 30.09.2022
https://doi.org/10.17826/cumj.1125732

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed medications and used for the treatment of depression and anxiety disorders mainly. SSRIs inhibit the serotonin transporter and lead depletion of serotonin in platelets. SSRIs in general, and paroxetine in particular, are associated with risk of bleeding. We report a case of spontaneous ecchymosis in young, healthy subject, after the use of paroxetine 20 mg / day. The paroxetine treatment was maintained and it was observed that the ecchymotic lesions were relieved. If the symptoms are mild and coagulation tests are normal in SSRI induced bleeding, it should be kept in mind that continuing the treatment with the same drug may be an option. Prospective studies are warranted in this area.

References

  • 1. Yüksel N (ed). Temel Psikofarmakoloji. Türkiye Psikiyatri Derneği, Ankara, 2010.
  • 2. Skop B, Brown T. Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors.Psycho-somatics. 1996;37:12–6.
  • 3. Oyesanmi O, Kunkel EJ, Monti DA, Field HL. Hematologic side effects of psychotropics. Psychosomatics. 1999;40:414-21.
  • 4. Ay R. Paroksetin Kullanımı ile İlişkili Ekimoz: Bir Olgu Sunumu. Klinik Psikiyatri. 2017;20:243-6.
  • 5. Halperin D, Reber G. Influence of antidepressants on hemostasis. Dialogues Clin Neurosci. 2007; 9:47-59.
  • 6. Salvia-Roiges MD, Garcia L, Gonce-Mellgren A, Esque-Ruiz MT, Figueras-Aloy J, Carbonell-Estrany X. Neonatal convulsions and subarachnoid hemorrhage after in utero exposure to paroxetine. Rev Neurol. 2003;36:724-6.
  • 7. Meijer WE, Heerdink ER, Nolen WA, Herings RM, Leufkens HG, Egberts AC. Association of risk of abnormal bleeding with degree of serotonin reuptake inhibition by antidepressants. Arch Intern Med. 2004;164:2367–70.
  • 8. Hergovich N, Aigner M, Eichler HG, Entlicher J, Drucker C, Jilma B. Paroxetine decreases platelet serotonin storage and platelet function in human beings. Clin Pharmacol Ther. 2000;68:435-42
  • 9. de Abajo FJ, Montero D, Rodriguez LA, Madurga M. Antidepressants and risk of upper gastrointestinal bleeding. Basic Clin Pharmacol Toxicol. 2006;98:304-10.
  • 10. Layton D, Clark DW, Pearce GL, Shakir SA. Is there an association between selective serotonin reuptake inhibitors and risk of abnormal bleeding? Results from a cohort study based on prescription event monitoring in England. Eur J Clin Pharmacol. 2001;57:167-76.
  • 11. Abdelmalik N, Ruhe HG, Barwari K, van den Dool EJ, Meijers JC, Middeldorp, S, et al. Effect of the selective serotonin reuptake inhibitor paroxetine on platelet function is modified by a SLC6A4 serotonin transporter polymorphism. J Thromb Haemost. 2008;6:2168-74.
  • 12. Wgner A, Montero D, Martensson B, Siwers B, Asberg M. Effects of fluoxetine treatment of platelet 3H-imipramine binding, 5-HT uptake and 5-HT content in major depressive disorder. J Affect Disord. 1990;20:101-13.
  • 13. Siddiqui R, Gawande S, Shende T, Tadke R, Bhave S, Kirpekar V. SSRI-induced coagulopathy: is it reality? Ther Adv Psychopharmacol. 2011;1:169–74.
  • 14. Şaylan M, Tukel R. Bleeding attributed to the use of Paroxetine. Klinik Psikofarmakoloji Bülteni. 2005;15:79-83.
  • 15. Blasco-Fontecilla H, de Leon J. Lower gastrointestinal bleeding and paroxetine use: two case reports. Psychosomatics. 2012;53(2):184-7.

Paroksetin ile ilişkili ekimoza farklı bir yaklaşım

Year 2022, Volume: 47 Issue: 3, 1378 - 1380, 30.09.2022
https://doi.org/10.17826/cumj.1125732

Abstract

Seçici serotonin gerialım inhibitörleri (SSGİ) sıklıkla reçete edilen ve başlıca depresyon ve anksiyete bozukluklarının tedavisinde kullanılan ilaçlardır. SSGİ ilaçlar serotonin taşıyıcısını inhibe ederek trombositlerdeki serotinin düzeylerinde azalmaya yol açarlar. SSGİ ilaçlar başta paroksetin olmak üzere anormal kanamalarla ilişkilendirilmiştir. Yazıda genç, sağlıklı olup, paroksetin 20 mg/gün kullanımı sonrası spontan ekimoz gelişen, tedavisine paroksetinle devam edilen ve takiplerinde ekimotik lezyonların azalarak geçtiği gözlenen bir olgu sunulmuştur. SSGİ ilaçlarla ilişkili kanama gelişmesi durumunda; belirtiler hafif ve koagülasyon testleri normalse, tedaviye aynı ilaçla devam etmenin de bir seçenek olabileceği akılda tutulmalıdır. Bu konuda geniş ölçekli izlem çalışmalarına ihtiyaç vardır.

References

  • 1. Yüksel N (ed). Temel Psikofarmakoloji. Türkiye Psikiyatri Derneği, Ankara, 2010.
  • 2. Skop B, Brown T. Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors.Psycho-somatics. 1996;37:12–6.
  • 3. Oyesanmi O, Kunkel EJ, Monti DA, Field HL. Hematologic side effects of psychotropics. Psychosomatics. 1999;40:414-21.
  • 4. Ay R. Paroksetin Kullanımı ile İlişkili Ekimoz: Bir Olgu Sunumu. Klinik Psikiyatri. 2017;20:243-6.
  • 5. Halperin D, Reber G. Influence of antidepressants on hemostasis. Dialogues Clin Neurosci. 2007; 9:47-59.
  • 6. Salvia-Roiges MD, Garcia L, Gonce-Mellgren A, Esque-Ruiz MT, Figueras-Aloy J, Carbonell-Estrany X. Neonatal convulsions and subarachnoid hemorrhage after in utero exposure to paroxetine. Rev Neurol. 2003;36:724-6.
  • 7. Meijer WE, Heerdink ER, Nolen WA, Herings RM, Leufkens HG, Egberts AC. Association of risk of abnormal bleeding with degree of serotonin reuptake inhibition by antidepressants. Arch Intern Med. 2004;164:2367–70.
  • 8. Hergovich N, Aigner M, Eichler HG, Entlicher J, Drucker C, Jilma B. Paroxetine decreases platelet serotonin storage and platelet function in human beings. Clin Pharmacol Ther. 2000;68:435-42
  • 9. de Abajo FJ, Montero D, Rodriguez LA, Madurga M. Antidepressants and risk of upper gastrointestinal bleeding. Basic Clin Pharmacol Toxicol. 2006;98:304-10.
  • 10. Layton D, Clark DW, Pearce GL, Shakir SA. Is there an association between selective serotonin reuptake inhibitors and risk of abnormal bleeding? Results from a cohort study based on prescription event monitoring in England. Eur J Clin Pharmacol. 2001;57:167-76.
  • 11. Abdelmalik N, Ruhe HG, Barwari K, van den Dool EJ, Meijers JC, Middeldorp, S, et al. Effect of the selective serotonin reuptake inhibitor paroxetine on platelet function is modified by a SLC6A4 serotonin transporter polymorphism. J Thromb Haemost. 2008;6:2168-74.
  • 12. Wgner A, Montero D, Martensson B, Siwers B, Asberg M. Effects of fluoxetine treatment of platelet 3H-imipramine binding, 5-HT uptake and 5-HT content in major depressive disorder. J Affect Disord. 1990;20:101-13.
  • 13. Siddiqui R, Gawande S, Shende T, Tadke R, Bhave S, Kirpekar V. SSRI-induced coagulopathy: is it reality? Ther Adv Psychopharmacol. 2011;1:169–74.
  • 14. Şaylan M, Tukel R. Bleeding attributed to the use of Paroxetine. Klinik Psikofarmakoloji Bülteni. 2005;15:79-83.
  • 15. Blasco-Fontecilla H, de Leon J. Lower gastrointestinal bleeding and paroxetine use: two case reports. Psychosomatics. 2012;53(2):184-7.
There are 15 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Letter to the Editor
Authors

Necla Keskin 0000-0003-3595-0746

Publication Date September 30, 2022
Acceptance Date June 27, 2022
Published in Issue Year 2022 Volume: 47 Issue: 3

Cite

MLA Keskin, Necla. “Paroksetin Ile ilişkili Ekimoza Farklı Bir yaklaşım”. Cukurova Medical Journal, vol. 47, no. 3, 2022, pp. 1378-80, doi:10.17826/cumj.1125732.