Do antidepressants and/or NSAIDs lead to MACE?
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Do antidepressants and/or NSAIDs lead to MACE? The risk of major adverse cardiovascular events (MACE) is moderately elevated with concomitant antidepressants and non-steroidal anti-inflammatory drugs (NSAIDs), according to study results reported in CNS Drugs, "driven by the concomitant use of tricyclic antidepressants [TCAs] and non-selective NSAIDs". The retrospective cohort study used data from South Korea’s National Health Insurance Service-National Sample Cohort (NHIS-NSC) in 2004–2015. The 240 982 patients who received new prescriptions for antidepressants (n=4393), NSAIDs (n=235 080) or both (n=1509) were identified. Exposure was divided by time into periods of nonuse, antidepressant use, NSAID use, or concomitant use; the median duration of concomitant use was 7 days. During 2.1 million person-years (PY) of follow-up, there were 22 453 occurrences of MACE, or 1.07 per 100PY. There was a positive association between MACE and concomitant NSAID and antidepressant use (hazard ratio [HR] 1.13; 95% CI 1.01, 1.26). There was also a positive association with NSAID use (HR 1.05; 1.001, 1.10), while there was a negative association with antidepressant use (HR 0.91; 0.83, 0.99). When stratified for age and sex, the risk of MACE was elevated with concomitant drug use in patients ≥45 years of age and male patients. For individual MACE components, concomitant drug use was associated with increased risk of haemorrhagic stroke, ischaemic stroke and heart failure, but a reduced risk of cardiovascular death. When each antidepressant drug class (SSRIs, SNRIs, TCAs) was combined with either selective or non-selective NSAIDs, the only significantly increased risk occurred with TCAs and non-selective NSAIDs (HT 1.26; 1.09, 1.47). "Our findings warrant healthcare providers taking precautions", note the authors, "weighing benefits and risks, before coprescribing these two drug classes". Jeong HE, et al. Risk of Major Adverse Cardiovascular Events Associated with Concomitant Use of Antidepressants and Non-steroidal Anti-inflammatory Drugs: A Retrospective Cohort Study CNS Drugs : 31 Jul 2020. Available from: URL: https://doi.org/10.1007/s40263-020-00750-4
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Reactions 22 Aug 2020 No. 1818
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