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 can add together and raise the risk of serotonin syndrome. St. John's Wort also induces CYP3A4 and CYP2B6, enzymes involved in tramadol metabolism, which may lower levels of tramadol's active M1 metabolite and weaken pain relief.
acetaminophen + n-acetylcysteine
N-acetylcysteine (NAC) is a cysteine donor the body uses to make glutathione, the same compound the liver relies on to neutralize acetaminophen's toxic metabolite NAPQI. NAC is the standard medical antidote for acetaminophen overdose, and routine co-use at supplement levels is considered protective rather than harmful. The safety boundary is the amount of acetaminophen taken, not the presence of NAC.
ibuprofen + ginkgo
Ibuprofen reduces platelet aggregation through COX-1 inhibition, and Ginkgo biloba has antiplatelet activity through ginkgolide B's antagonism of platelet-activating factor. Used together they can compound the effect on platelets and raise bleeding risk; a fatal intracerebral hemorrhage has been reported in a long-term ginkgo user who started regular ibuprofen.
tramadol + 5-htp
Tramadol blocks the reuptake of serotonin, and 5-HTP is a direct precursor that raises serotonin production in the brain. Stacking the two can push serotonin activity too high and trigger serotonin syndrome, a potentially life-threatening reaction.
naproxen + fish oil
Naproxen and fish oil both mildly reduce platelet aggregation through separate pathways, so their effects are additive in theory. Pooled clinical-trial data show no meaningful increase in major bleeding at typical doses.
acetaminophen + milk thistle
Milk thistle's active component silymarin reduces CYP2E1 activity and supports hepatic glutathione, the same pathways that govern acetaminophen safety, so it may add a mild margin of liver support. The protective effect is shown mainly in animal studies; human clinical benefit is plausible but not established. The combination is considered low-risk, but milk thistle is not a substitute for safe acetaminophen dosing and is never a treatment for overdose.