Drug General Information (ID: DDIF8M1VCE)
Drug Name			Danaparoid		Drug Info		Levomilnacipran		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anticoagulants				Snris/Antidepressants

Mechanism of Danaparoid-Levomilnacipran Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Danaparoid				Levomilnacipran
Mechanism		Risk of bleeding Anticoagulant				Risk of bleeding Antiplatelet effects
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Danaparoid and Levomilnacipran

Recommended Action
Management		Caution is recommended if a serotonin reuptake inhibitor is administered with heparin therapy, especially in the elderly and patients with renal impairment. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References
1	Alderman CP, Moritz CK, Ben-Tovim DI "Abnormal platelet aggregation associated with fluoxetine therapy." Ann Pharmacother 26 (1992): 1517-9. [PMID: 1482806]
2	Alderman CP, Seshadri P, Ben-Tovim DI "Effects of serotonin reuptake inhibitors on hemostasis." Ann Pharmacother 30 (1996): 1232-4. [PMID: 8913401]
3	Aranth J, Lindberg C "Bleeding, a side effect of fluoxetine." Am J Psychiatry 149 (1992): 412. [PMID: 1536285]
4	de Maistre E, Allart C, Lecompte T, Bollaert PE "Severe bleeding associated with use of low molecular weight heparin and selective serotonin reuptake inhibitors." Am J Med 113 (2002): 530-2. [PMID: 12427509]
5	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 68 (2000): 435-42. [PMID: 11061584]
6	Humphries JE, Wheby MS, VandenBerg SR "Fluoxetine and the bleeding time." Arch Pathol Lab Med 114 (1990): 727-8. [PMID: 2363631]
7	Krivy J, Wiener J "Sertraline and platelet counts in idiopathic thrombocytopenia purpura." Lancet 345 (1995): 132. [PMID: 7815874]
8	Leung M, Shore R "Fluvoxamine-associated bleeding." Can J Psychiatry 41 (1996): 604-5. [PMID: 8946088]
9	Messiha FS "Fluoxetine - adverse effects and drug-drug interactions." J Toxicol Clin Toxicol 31 (1993): 603-30. [PMID: 8254702]
10	Ottervanger JP, Stricker BH, Huls J, Weeda JN "Bleeding attributed to the intake of paroxetine." Am J Psychiatry 151 (1994): 781-2. [PMID: 8166328]
11	Pai VB, Kelly MW "Bruising associated with the use of fluoxetine." Ann Pharmacother 30 (1996): 786-8. [PMID: 8826562]
12	Product Information. Brintellix (vortioxetine). Takeda Pharmaceuticals America, Lincolnshire, IL.
13	Product Information. Celexa (citalopram). Forest Pharmaceuticals, St. Louis, MO.
14	Product Information. Cymbalta (duloxetine). Lilly, Eli and Company, Indianapolis, IN.
15	Product Information. Effexor (venlafaxine). Wyeth-Ayerst Laboratories, Philadelphia, PA.
16	Product Information. Fetzima (levomilnacipran). Forest Pharmaceuticals, St. Louis, MO.
17	Product Information. Lexapro (escitalopram). Forest Pharmaceuticals, St. Louis, MO.
18	Product Information. Luvox (fluvoxamine). Solvay Pharmaceuticals Inc, Marietta, GA.
19	Product Information. Paxil (paroxetine). GlaxoSmithKline, Research Triangle Park, NC.
20	Product Information. Pristiq (desvenlafaxine). Wyeth Laboratories, Philadelphia, PA.
21	Product Information. Prozac (fluoxetine). Dista Products Company, Indianapolis, IN.
22	Product Information. Savella (milnacipran). Forest Pharmaceuticals, St. Louis, MO.
23	Product Information. Zoloft (sertraline). Roerig Division, New York, NY.
24	Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30. [PMID: 9796863]
25	Skop BP, Brown TM "Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors." Psychosomatics 37 (1996): 12-6. [PMID: 8600488]
26	Yaryura-Tobias JA, Kirschen H, Ninan P, Mosberg HJ "Fluoxetine and bleeding in obsessive-compulsive disorder." Am J Psychiatry 148 (1991): 949. [PMID: 2053641]
27	Layton D, Clark DWJ, Pearce GL, Shakir SAW "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 57 (2001): 167-76. [PMID: 11417450]