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Pharmacy and Medications

Interaction with Prescription Drugs



Will mixing the following drugs cause problems: omeprazole, tramadol, hydroxychlor, amlodipine besylate, paroxetine, premarin, plavix, losartan, enalapril, furosamine, oxybutynin, multi-vitamins,vitamin c, calcium, folic acid and milk thistle?


The majority of these medications are safe to take together. You should be aware of the following potential interactions and discuss them with your prescriber and/or pharmacist: Clopidogrel (Plavix) and omeprazole: This interaction leads to a decreased effect of the clopidogrel. There is a lot of controversy in medical studies as to whether this interaction is clinically significant.

clopidogrel (Plavix) and amlodipine: amlodipine and similar drugs can block the activation of clopidogrel in the body, reducing the effectiveness of clopidogrel.

clopidogrel (Plavix) and paroxetine: Several studies have found an increased risk of bleeding in patients taking selective serotonin reuptake inhibitors (SSRIs) and clopidogrel (Plavix).

Paroxetine and tramadol: Paroxetine acts as an SSRI, increasing the amount of serotonin available at serotonin receptors. In addition to its ability to control pain, tramadol also increases the amount of serotonin available at these receptors and can lead to too much serotonin. Also, depending on your reason for being on clopidogrel (Plavix), you may want to discuss the risk of clotting that is associated with hormone replacement medications like Premarin.

You should know that Milk Thistle is not studied and may have undocumented drug interactions that have not been identified in the medical literature.

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Response by:

Michael  Ganio, PharmD Michael Ganio, PharmD
Clinical Applications Pharmacist
Wexner Medical Center
The Ohio State University