pain
6 interactions related to pain
tramadol + st. john's wort
Tramadol inhibits serotonin and norepinephrine reuptake, and St. John's Wort increases central serotonergic activity, so combining them raises the risk of serotonin syndrome. St. John's Wort also induces CYP3A4 and CYP2B6, which can reduce tramadol's active M1 metabolite and weaken analgesia.
acetaminophen + n-acetylcysteine
N-acetylcysteine (NAC) replenishes hepatic glutathione, which the liver uses to detoxify the toxic acetaminophen metabolite NAPQI. NAC is the standard antidote for acetaminophen overdose, and routine co-use at supplement doses is considered protective rather than harmful.
ibuprofen + ginkgo
Ibuprofen inhibits platelet aggregation through COX-1, and Ginkgo biloba inhibits platelet-activating factor through ginkgolide B. Combining them increases the risk of bleeding, with case reports of fatal intracerebral hemorrhage.
tramadol + 5-htp
Tramadol inhibits serotonin reuptake, and 5-HTP is a direct precursor to serotonin that increases central serotonin synthesis. Combining them can cause serotonin syndrome, a potentially life-threatening reaction.
naproxen + fish oil
Naproxen impairs platelet aggregation through COX-1 inhibition, and fish oil EPA and DHA have mild antiplatelet and antithrombotic effects. Combining them can modestly increase bleeding risk, especially at high doses or alongside other blood thinners.
acetaminophen + milk thistle
Milk thistle's active component silymarin reduces CYP2E1 activity and supports hepatic glutathione, both of which limit formation of the toxic acetaminophen metabolite NAPQI. Animal studies show clear protection, and the combination is considered low-risk; clinical benefit in humans is plausible but not firmly established.