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Painkillers & Blood Thinners And Other Interactions

interactions with pain medications

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Painkillers have all but become a part of a daily routine for a large number of people across the world. As a result, people, even unknowingly, mix pain meds with other drugs, like blood thinners, antidepressants, stimulants, and others. Drug interactions are usually not affected by the drug formulation – for example, liquid pain medications will likely have the same interactions as those formulated as pills or powder.

As nowadays, customers can buy pain medication online, it becomes increasingly easier to get a hold of these drugs and to combine them with other medicines. Some individuals even mix these drugs with weed, cocaine and other substances to get stronger “high” effects. Numerous dangerous consequences, like pain medication side effects, can appear, especially after mixing painkillers and other drugs.

The interaction of painkillers and other substances can sometimes have a beneficial effect. For example, aspirin which has an anticoagulant effect is sometimes combined with blood thinners to achieve the best effect.

To avoid the adverse reactions caused by the interaction of various drugs, it’s advised to consult a doctor before using/mixing them.
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Learn About Painkillers Interactions:

Pain Medications With Blood Thinners

Although some painkillers (like aspirin) and blood thinners are sometimes used together, mixing them can lead to excessive bleeding and wounds that won’t heal. What kind of pain medication can one take with blood thinners? Doctors should recommend pain meds that won’t have dangerous interactions with blood thinners (e.g., won’t cause bleeding that doesn’t stop). Taking proton pump inhibitor and stomach-protective drugs might also help, as bleeding will usually occur in the stomach.

  • What type of pain medication is safe with Eliquis? Mixing Equate acetaminophen with blood thinners like eliquis won’t cause the aforementioned adverse reactions, and the same goes for Vicodin.
  • What pain medication can one take with warfarin? Usually, doctors recommend the combination of Tylenol (another acetaminophen drug) and Coumadin (warfarin).
  • What pain medication can one take with Xarelto? Any drug with paracetamol as its main ingredient can be used with Xarelto, such as Percocet.
  • What painkillers can one take with clopidogrel? Feverall, Abenol, Acephen, and any other acetaminophen-based drug can be used in combination with clopidogrel.

Most anti-inflammatory painkillers shouldn’t be used with blood thinners. Non-steroidal anti-inflammatory remedies, like ibuprofen and aspirin, will prevent the forming of blood clots.

Ask a doctor to find the most suitable pain medication to use with blood thinners.

Pain Medications With Antidepressants

The combination of antidepressants and painkillers can cause serious internal stomach bleeding and other adverse reactions. The headache won’t go away with painkillers if mix them with antidepressants, as many people think. While antidepressants might relieve migraine and chronic tension headache, mixing them with pain meds can inhibit the beneficial effects of both substances.

  • What pain medication can one take with antidepressants? Acetaminophen-based drugs, some of the most common pain meds, usually don’t have dangerous interactions with most antidepressants. Taking tramadol (Ultram) with antidepressants should be safe if the doctor’s suggestions are followed.
  • Can one take muscle relaxers with painkillers? Less potent muscle relaxers like methocarbamol can be used in combination with painkillers like acetaminophen. Carisoprodol, on the other hand, is a much more powerful muscle relaxer, and mixing it with other painkillers should be avoided.
  • What painkillers can one take with Venlafaxine? Paracetamol shouldn’t have any hazardous interactions with Venlafaxine, which why it’s safe to use. On the other hand, ibuprofen and aspirin should be taken only after consulting the physician.
  • What pain medication can be taken with Cymbalta? Tylenol won’t have as many adverse reactions as when Cymbalta is mixed with MAOIs (monoamine inhibitors), such as Parnate and Eldepryl). However, Cymbalta still may increase the blood level, so a doctor’s advice is required.
  • What painkillers can one take with Prozac? Prozac (fluoxetine) and paracetamol, like Lortab (a prescription drug), don’t have dangerous interactions. Taking fluoxetine with diclofenac, ibuprofen, and Naproxen is not advised.

Pain Medications With Antidepressants

Stimulants And Painkillers

Interactions With Amphetamine Containing Drugs

Stimulants (like amphetamine, MDMA, and methamphetamine) can produce serious side effects if used in combination with painkillers. Mixing amphetamine and its derivatives with opioid painkillers (such as oxycodone) is not recommended, as one Milwaukee Heart Institute study suggests. Taking Adderall and aspirin isn’t likely to produce conspicuous adverse reactions, but a medical specialist should be consulted before proceeding with use.

Amphetamine abuse tends to co-occur with opioid drug use, which increases the risk of codependency. Physical signs of addiction to painkillers and amphetamines are conspicuous and include various withdrawal symptoms like:

  • Shivering
  • Nausea
  • Fever
  • Inability to concentrate

Adderall and painkillers can be used safely when this stimulant is used in combination with ibuprofen. On the other hand, mixing Adderall with antidepressants should be avoided, as hallucinations and seizures may appear.

Mixing MAOI antidepressants (like Nardil and Parnate) with MDMA will produce a plethora of side effects and even death. MDMA and aspirin (or salicylate) won’t have such a drastic interaction, but dehydration might appear.

Can one take pain meds with Vyvanse? Yes, but not all pain meds should be used with Vyvanse. Usually, ibuprofen is recommended to use with Vyvanse, but it’s advised to consult a doctor to find the right medication.

Cocaine And Painkillers

A combination of cocaine and painkillers, especially opioids, is an extremely dangerous one. Respiratory failure, palpitations, arrhythmia, and other cardiovascular symptoms are just some of the outcomes of mixing cocaine with pain meds.

What are the dangers of getting high off painkillers and cocaine? Cocaine, as an extremely potent substance, might cause adverse reactions even when used with low doses of painkillers.

Mixing cocaine with any kind of pain meds is strongly not advised, as health complications, liver damage, and other health issues may occur.

Antibiotics And Painkillers

Can one take painkillers with antibiotics? As antibiotics treat infections and not pain, mixing these drugs is the usual practice. Paracetamol (acetaminophen) is safe to use with most antibiotics, except rifampicin, which is a powerful antibiotic used to treat tuberculosis. The interaction between paracetamol and rifampicin may cause serious liver damage. However, taking antibiotics and painkillers together should also be managed by the medical specialist only.

  • What painkillers can one take with doxycycline? Mixing ibuprofen with doxycycline is a safe way to treat the pain while alleviating the infection.
  • What painkillers can one take with levofloxacin? Paracetamol can be used with levofloxacin, while doctors don’t recommend the combination of levofloxacin and anti-inflammatories like ibuprofen, aspirin, and Naproxen. One study failed to find significant interactions between levofloxacin and oxycodone.

Antibiotics and Painkillers Interaction

Pain Medications And Heart Medication

What painkillers can one take with heart medication? The answer depends on the type of heart condition one suffers from.

As NSAIDs like ibuprofen and Naproxen increase the blood pressure, people taking medicine for hypertension should avoid taking these painkillers. Instead, acetaminophen-based drugs can be taken.

Antidepressants, which are sometimes used as meds for nerve pain, can annulate the effect of various drugs for heart conditions. For example, mixing some SNRIs (serotonin and noradrenaline reuptake inhibitors), like venlafaxine with hypertension medicine will lead to high blood pressure. Similarly, MAOIs (monoamine oxidase inhibitors), known to cause irregular heartbeat shouldn’t be used in combination with medicine for arrhythmia.

The only certain way to avoid dangerous interactions between pain meds and heart medications is to consult a doctor. Self-medication may lead to the prominence of serious health risks.

Sleeping Pills With Painkillers

Mixing sleeping pills with painkillers may lead to death, especially if stronger prescription pain meds (opioids) are used in combination with sleeping pills. This is the case when benzodiazepines are used for treating insomnia and other sleep disorders.

Taking melatonin sleeping pills may solve this problem, but mixing them with opioids will result in excessive sleepiness. Melatonin may slow down the liver functioning which in turn might slow down the breaking up of acetaminophen, clopidogrel, and diazepam. This means that these painkillers will stay in the system for a longer time and will result in stronger effects (and side effects).

Sleeping pills and various OTC drugs (like ibuprofen and aspirin) aren’t known to cause serious health risks.

Sleeping Pills With Painkillers

Painkillers and Weed

Marijuana and painkillers shouldn’t be used together. Marijuana is a drug, the exact effects of which are relatively unknown, which means that even adverse reactions are unpredictable. Weed and painkillers (more specifically, benzodiazepines) can have a particularly dangerous interaction, which may result in an overdose.

Marijuana and painkillers like aspirin can be used together in some states of the U.S. where this drug is approved for medical use, as marijuana has anti-inflammatory properties. This is only suitable for specific health conditions, and under the close supervision of a doctor.

Despite marijuana is approved for medical use in some states, it still can be addictive if used for recreational purposes. Moreover, addiction development is likely to appear faster when these substances are consumed together.

Caffeine And Painkillers

Mixing caffeine and painkillers like ibuprofen might increase the analgesic effect of ibuprofen. Painkillers and coffee often come together, as ibuprofen and paracetamol contain certain levels of caffeine to boost the effectiveness of these medicines.

Taking pain meds with caffeine is a potentially damaging combination for the liver if coffee is drunk in large amounts (more than 3 cups per day). Conversely, caffeine might have a dangerous interaction with opioid painkillers, as one Japanese study suggests.

Avoid Dangerous Interactions With Painkillers

Mixing different types of medications without consulting the doctor should be avoided at all costs. Even when over-the-counter painkillers are consumed, the doctor should assess the potential dangers of mixing different substances. People often experience side effects of combining painkillers with other substances because they often prefer self-medication and ask the treatment advice via the internet.

How to ask for pain medication, and avoid adverse reactions to painkiller combinations? A medical professional must be provided with all the important information about the patient’s health condition, and especially about the painkillers that are used. Only in this case, a doctor can correctly assess which combination of drugs will carry the least amount of risk. A certain combination of pain meds may be completely harmless for some people while being potentially life-threatening for others. The doctor might demand pain medication contracts to be signed by the patient when controlled painkillers are prescribed, and its correct implementation will help to avoid negative effects.

Taking any painkillers while pregnant might be harmful on its own, let alone combining different classes of drugs. If any adverse reactions are noticed, call the drug helpline immediately. There are many techniques for pain management without medication, which can be useful during pregnancy. However, the alternative medication should also be approved by a doctor.

The combination of pain meds and various other substances is often seen in multiple types of addictions. Fortunately, there are many addiction treatment options available for different kinds of abuses caused by mixing painkillers with other substances. People with substance abuse problems can find help in numerous rehabilitation centers all over the United States, which is an efficient way to battle an addiction.

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Hope Without Commitment

Find the best treatment options. Call our free and confidential helpline

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  1. Smitherman TA, Walters AB, Maizels M, Penzien DB. The use of antidepressants for headache prophylaxis. 2011.
  2. Jing-Tao Zhang, Ke-Ping Chen, Shu Zhang. Efficacy and Safety of Oral Anticoagulants Versus Aspirin for Patients With Atrial Fibrillation. 2015.
  3. Corey PJ, Heck AM, Weathermon RA. Amphetamines to counteract opioid-induced sedation. 1999.
  4. SHANE DARKE, JOANNE ROSS, JULIA COHEN. The use of benzodiazepines among regular amphetamine users. 1994.
  5. Grant EM, Zhong M, Fitzgerald JF, Nicolau DP, Nightingale C, Quintiliani R. Lack of interaction between levofloxacin and oxycodone: pharmacokinetics and drug disposition. 2001.
  6. Ruth Gallily, Zhannah Yekhtin, Lumír Ondřej Hanuš. The Anti-Inflammatory Properties of Terpenoids from Cannabis. 2018.
  7. Kuribara H, Uchihashi Y. Interactions of opioids with caffeine: evaluation by ambulatory activity in mice. 1994.
Roger Weiss

About Author

Roger Weiss, MD

Dr. Roger Weiss is a practicing mental health specialist at the hospital. Dr. Weiss combines his clinical practice and medical writing career since 2009. Apart from these activities, Dr. Weiss also delivers lectures for youth, former addicts, and everyone interested in topics such as substance abuse and treatment.


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