Objective: To report a case of spontaneous bruising with concomitant use of nonsteroidal antiinflammatory drugs (NSAIDs) and citalopram.Case Summary: A 34-year-old white woman with a history of chronic thrombocytopenia (baseline platelet count 120-130 x 103/|uL) presented to the emergency department (ED) after noticing an increase in bruising on her upper and lower extremities. When the patient was interviewed, it was found that her dose of citalopram had been recently increased from 20 to 40 mg/day and she had started ibuprofen (dose unknown) on her own to manage rib pain approximately 1 month after the citalopram dosage increase. The patient was advised to discontinue ibuprofen and was discharged. Shortly thereafter, she was started on oxaprozin 600 mg twice daily for management of trochanteric bursitis. She returned to the ED stating that bruising occurred 1 week after she was given oxaprozin. At this visit, the patient was told to discontinue oxaprozin and naproxen 440 mg twice daily was prescribed. One week later, the patient again returned to the ED with complaints of spontaneous bruising. At this point citalopram and naproxen were discontinued and she was started on acetaminophen (dose not documented) and buspirone 10 mg twice daily. No other episodes of ecchymosis have occurred in the 8 months since this change to her drug regimen.Discussion: Medications that increase the risk of bleeding should be carefully administered in patients who have a low platelet count. This patient experienced bruising when her dose of citalopram was increased and an increase in bruising when she combined an NSAID with citalopram. Selective serotonin reuptake inhibitors (SSRIs) may increase antiplatelet activity of NSAIDs and could therefore increase the risk of bruising. Use of the Horn Drug Interaction Probability Scale indicated a possible interaction with concomitant use of NSAIDs and citalopram.Conclusions: Patients who experience NSAID- and/or SSRI-related bruising should consult their providers and alternative treatments should be considered.
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机译：目的：报告一例同时使用非甾体类抗炎药（NSAIDs）和西酞普兰的自发性瘀伤病例。病例摘要：一名34岁的白人女性，有慢性血小板减少症病史（基线血小板计数120-130 x 103 / |）。注意到上肢和下肢的瘀伤有所增加后，就送给急诊科（ED）。在对患者进行采访时，发现她的西酞普兰剂量最近从20毫克/天增加到她的剂量，并且在西酞普兰剂量增加约1个月后开始自行服用布洛芬（剂量未知）来控制肋骨疼痛。建议患者停用布洛芬并出院。此后不久，她开始每天服用两次600 mg的oxaprozin来治疗股骨转子滑囊炎。她返回急诊室，指出在给他服奥沙普林1周后出现青紫。在该次就诊时，告知患者停用奥沙普嗪，并处方每天两次440毫克萘普生。一周后，患者因自发性瘀伤而再次回到急诊科。此时，停用西酞普兰和萘普生，并开始服用对乙酰氨基酚（未记录剂量）和丁螺环酮10毫克，每天两次。自从改变药物治疗方案以来的8个月内，没有其他瘀斑发作。讨论：对于血小板计数低的患者，应谨慎服用增加出血风险的药物。当增加西酞普兰的剂量时，该患者出现青紫，而将NSAID与西酞普兰联合使用时，青紫增加。选择性5-羟色胺再摄取抑制剂（SSRIs）可能会增加NSAIDs的抗血小板活性，因此可能增加青紫的风险。使用角质药物相互作用概率量表表明可能与NSAIDs和西酞普兰同时使用发生相互作用。结论：患有NSAID和/或SSRI相关青紫的患者应咨询其提供者，并应考虑选择其他治疗方法。
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