Plavix (clopidogrel) is a brand-name prescription drug used to lower the risk of heart attack and stroke in adults who:

As with other medications, Plavix can interact with certain other drugs. An interaction occurs when one substance causes another substance to have a different effect than expected.

For more about Plavix’s interactions, keep reading. For additional information about Plavix, including details about its uses, see this article.

In some cases, a factor or condition could prevent your doctor from prescribing Plavix due to the risk of harm. This is known as a contraindication. The contraindications of Plavix include:

Having an active bleed

An active bleed refers to bleeding that’s currently occurring in your body. Examples include stomach ulcers and brain bleeds. Doctors typically will not prescribe Plavix if you have an active bleed. The bleed should be treated before you start taking the drug.

Plavix works by making it harder for your blood to clot. This is useful for helping prevent heart attack and stroke, which can be caused by clots. However, with your blood less able to clot, Plavix could make an active bleed worse and harder to treat.

Having had an allergic reaction to Plavix or any of its ingredients

If you’ve had an allergic reaction to Plavix or any of its ingredients, your doctor will likely not prescribe Plavix. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Plavix, it’s important to tell your doctor if any of these contraindications apply to you. They can determine whether to prescribe Plavix.

There’s no known interaction between taking Plavix and drinking alcohol.

However, consuming large amounts of alcohol over time can increase your risk of gastritis (inflammation of the stomach lining). This can result in bleeding.

Bleeding is a known side effect of Plavix. So, it’s possible that you could have an increased risk of a stomach bleed if you take Plavix and drink alcohol in large amounts.

If you drink alcohol, be sure to let your doctor know before you start taking Plavix. They can advise you on how much, if any, may be safe to have during your treatment.

* To learn about the side effects of Plavix, see this article.

Before you start treatment with Plavix, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Plavix. Keep in mind that this chart does not include all drugs that may interact with Plavix. Some of these interactions are described in detail just below in “Drug interactions in depth.”

Drug class or drug nameDrug examplesInteraction result with Plavix
CYP2C19 inhibitors• omeprazole (Prilosec)
• esomeprazole (Nexium)
can make Plavix less effective than usual
CYP2C19 inducers• rifampin (Rimactane)can increase the risk of side effects of Plavix*
nonsteroidal anti-inflammatory drugs (NSAIDs)aspirin
• ibuprofen (Advil, Motrin, others)
can increase the risk of side effects of NSAIDs and Plavix*
selective serotonin reuptake inhibitors (SSRIs)• sertraline (Zoloft)
• paroxetine (Paxil)
can increase the risk of side effects of Plavix*
serotonin and norepinephrine reuptake inhibitors (SNRIs)• duloxetine (Cymbalta)
• venlafaxine (Effexor XR)
can increase the risk of side effects of Plavix*
anticoagulants• warfarin (Jantoven)
• rivaroxaban (Xarelto)
• apixaban (Eliquis)
• dabigatran (Pradaxa)
can increase the risk of side effects of anticoagulants and Plavix*
repaglinidecan increase the risk of side effects of repaglinide

* To learn about the side effects of Plavix, see this article.

Here’s a closer look at certain drug interactions of Plavix.

CYP2C19 inhibitors

Plavix may interact with drugs that are CYP2C19 inhibitors.

“CYP” stands for cytochrome p450. This refers to a group of enzymes, which are proteins that speed up chemical processes in your body. CYP enzymes help your body break down certain medications after you take a dose.

Interaction result. This interaction may decrease the level of Plavix in your body, making the drug less effective than usual.

Interaction explained. Plavix is a type of medication known as a pro-drug. This means that when you take a dose, the medication needs to become activated in your body in order to work. Plavix becomes activated when CYP2C19 breaks the medication down into its active form.

Medications that inhibit (block) the actions of CYP2C19 can prevent Plavix from becoming activated in your body. This means Plavix may not work as well as usual or not work at all.

Examples of CYP2C19 inhibitor drugs. Here are some CYP2C19 inhibitors: omeprazole (Prilosec) and esomeprazole (Nexium).

Steps you or your doctor may take. Doctors typically will avoid prescribing Plavix if you’re taking a CYP2C19 inhibitor such as omeprazole or esomeprazole. They’ll likely recommend you either stop taking the CYP2C19 inhibitor or they’ll recommend a different treatment than Plavix.

Selective serotonin reuptake inhibitors (SSRIs)

Plavix may interact with a group of drugs known as selective serotonin reuptake inhibitors (SSRIs). These are medications prescribed to treat major depressive disorder and other mental health conditions such as generalized anxiety disorder.

Interaction result. This interactioncan increase the risk of bleeding, a known side effect of Plavix. (To learn about the side effects of Plavix, see this article.)

Interaction explained. Plavix works by making it harder for your blood to clot. This lowers your risk of having a blood clot, but it also increases your risk of bleeding.

SSRIs can indirectly affect your blood’s ability to clot. So, taking an SSRI during Plavix treatment may further increase your risk of bleeding.

Examples of SSRIs. Here are some SSRIs:

  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • fluoxetine (Prozac)
  • citalopram (Celexa)
  • escitalopram (Lexapro)

Steps you or your doctor may take. If your doctor prescribes Plavix and you’re taking an SSRI, they may take various steps. These can include closely monitoring you for signs of bleeding and lowering the dose of your SSRI. The steps can also include recommending a treatment other than Plavix or the SSRI.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a type of medication used to relieve pain, and they may interact with Plavix.

Interaction result. Taking Plavix and an NSAID together can increase the risk of bleeding, including severe bleeding.

Interaction explained. Both Plavix and NSAIDs can cause bleeding. This is because both medications can affect your blood’s ability to clot. Combining these medications can increase your risk of bleeding, including having a bleed inside your digestive tract.

Examples of NSAIDs. Here are some NSAIDs:

  • ibuprofen (Advil, Motrin, others)
  • naproxen (Aleve)
  • aspirin
  • celecoxib (Celebrex)
  • meloxicam (Mobic)

Steps you or your doctor may take. Because of the interaction risk, you should talk with your doctor before taking an NSAID during Plavix treatment. They can advise you on whether it’s safe to take an NSAID or if you should take a different pain reliever, such as acetaminophen (Tylenol).

Plavix may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Plavix.

Plavix and supplements

It’s possible for drugs to interact with supplements such as vitamins and herbs.

Plavix and herbs

There have been no specific reports of herbs interacting with Plavix. However, it’s possible that interactions with herbs could be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Plavix treatment.

Plavix and vitamins

No vitamins have been reported to interact with Plavix. However, it’s possible that interactions with vitamins could be recognized in the future. This is why you should talk with your doctor or pharmacist before taking any vitamin product with Plavix.

Plavix and food

There have been no reports of food interactions with Plavix. If you’d like to learn more about eating certain foods during treatment with Plavix, talk with your doctor.

Plavix and vaccines

Plavix is not known to interact with any vaccines. If you have any questions about getting vaccines during Plavix treatment, talk with your doctor or pharmacist.

Plavix and lab tests

There are not any lab tests known to interact with Plavix. Your doctor can help answer any questions you have about getting lab tests during Plavix treatment.

Plavix and cannabis or CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Plavix. However, as with any drug or supplement, talk with your doctor before taking cannabis in combination with Plavix. The impact of cannabis may affect how well you stick to your Plavix treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Plavix. Before you take Plavix, be sure to talk with your doctor about your health history. Plavix may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Plavix include:

  • Problems with the CYP2C19 enzyme. If you’re missing an enzyme called CYP2C19 or if it’s not working properly, your body may not be able to process Plavix. This means the drug may be less effective than usual. In fact, Plavix has a boxed warning about the risk of reduced effectiveness in certain people. This is a serious warning from the Food and Drug Administration (FDA). To learn more, see the boxed warning at the top of this article.
  • Active bleed. If you have an active bleed, such as a stomach ulcer, it will typically need to be treated before you can take Plavix. (An active bleed refers to current bleeding in your body.) For more information, see “When to avoid Plavix” above.
  • Bleeding problems. If you have a bleeding problem, such as hemophilia, be sure to let your doctor know before you start taking Plavix. The drug works by making it harder for your blood to clot. With your blood not clotting as well, Plavix may not be safe to take if you have hemophilia or another bleeding problem. You can ask your doctor whether Plavix or another treatment is the right option for you.
  • Scheduled surgery. Before starting treatment with Plavix, be sure to let your doctor know about any scheduled surgeries you may have. This includes any dental procedures. Plavix can increase your risk of bleeding, and bleeding is a potential complication of many surgeries. Your doctor may want you to wait to start taking Plavix until after your procedure. Or, they may have you stop taking the medication a few days prior to the surgery.
  • Pregnancy. It’s not known if it’s safe to take Plavix while pregnant. If you’re pregnant or planning to become pregnant, talk with your doctor before you start taking Plavix. They can discuss treatments with you.
  • Breastfeeding. It’s not known whether it’s safe to take Plavix while breastfeeding. If you’re taking Plavix and considering breastfeeding, talk with your doctor about your options.
  • Allergic reaction. If you’ve had an allergic reaction to Plavix or any of its ingredients, your doctor will likely not prescribe Plavix. For more information, see “When to avoid Plavix” above.

Here are some frequently asked questions about Plavix and possible interactions.

Can you drink coffee while taking Plavix?

Yes, it should be safe to consume coffee or other drinks with caffeine while taking Plavix. The drug is not known to interact with any beverages or foods. Your doctor or pharmacist can help answer any additional questions you have.

Do proton pump inhibitors (PPIs) such as Protonix interact with Plavix?

Certain, but not all, proton pump inhibitors (PPIs) interact with Plavix.

Doctors typically will not prescribe the PPIs esomeprazole (Nexium) and omeprazole (Prilosec) with Plavix. Research showed that these two PPIs can make Plavix significantly less effective than usual.

On the other hand, the following PPIs may be safer to take with Plavix:

  • pantoprazole (Protonix)
  • dexlansoprazole (Dexilant)
  • lansoprazole (Prevacid)

Although these three PPIs can also make Plavix less effective, the effect is not as severe as with esomeprazole or omeprazole. So, it may be safe to take these PPIs with Plavix, but only if your doctor specifically says so.

If you’re taking a PPI such as Protonix, it’s important to talk with your doctor before you start Plavix treatment. They can advise you on whether the PPI is safe to take with Plavix. If it’s not, your doctor can suggest alternatives for either drug.

Is it safe to take Tylenol during Plavix treatment?

In general, yes. It’s believed that acetaminophen (Tylenol) and Plavix do not interact, so they should be safe to take together if your doctor agrees.

Acetaminophen is a pain reliever that may be purchased over the counter (OTC) without a prescription.

Other OTC and prescription pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs) do interact with Plavix. To learn more, see “Drug interactions explained” above.

If you feel you need Tylenol or another pain reliever while taking Plavix, talk with your doctor.

Will atorvastatin and Plavix interact if I take them together?

No, atorvastatin (Lipitor) and Plavix are not expected to interact. It’s believed these medications are safe to take together. In fact, they’re prescribed together frequently.

For example, both atorvastatin and Plavix may be prescribed to people who have had a heart attack. This combination is endorsed in guidelines from the American College of Cardiology and American Heart Association. The guidelines are for people who have had a certain type of acute coronary syndrome.

If you have additional questions about atorvastatin and Plavix, talk with your doctor.

You can take certain steps to help prevent interactions with Plavix. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

  • Let them know if you drink alcohol or take cannabis.
  • Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
  • Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the label of Plavix and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Plavix does not come with paperwork, you can ask your pharmacist to print a copy for you.) If this information is difficult to understand, ask your doctor or pharmacist to help explain it.

You can also help prevent interactions with Plavix by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Plavix. These resources might help:

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.