Moderate
Prednisolone × Sertraline
Glucocorticoids×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Prednisolone is ulcerogenic — suppresses prostaglandin synthesis and gastric mucosal turnover. Sertraline 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 disease.
Management
On the combination, in patients over 65, with prior peptic ulcer, or on long-term prednisolone (over 2 weeks), add pantoprazole 20 mg/day. For short courses (3–7 days), additional gastroprotection is not mandatory.