Moderate
Escitalopram × Prednisolone
Selective serotonin reuptake inhibitors (SSRIs)×Glucocorticoids
Mechanism
Prednisolone is ulcerogenic; escitalopram reduces platelet aggregation via serotonin uptake. Additive GI bleeding risk.
Symptoms
Epigastric pain, heartburn, black or tarry stools, blood in vomit, bruising. Higher risk in older patients and prior peptic ulcer.
Management
On long-term prednisolone (over 2 weeks) or in patients over 65, add pantoprazole 20 mg/day. Escitalopram also prolongs QT, so cap older patients at 10 mg/day.