barb asked
I was prescribed prozac and I take plavix. I'm afraid of having a stroke. My doctor is insisting I take it. I have had 3 T.I.A. s already. Thank you.
Answer
There is legitimate reason for concern here... Prozac (fluoxetine) and Plavix (clopidogrel) have a fairly serious interaction with one another.
Prozac Interaction With Plavix
Plavix is a prodrug, meaning the drug you take is not active when you first swallow the pill. Only after being absorbed through the intestine and sent through the liver is this drug converted into its active form.
This active form of Plavix then binds to platelets in your blood, and decreases their ability to bunch together. Much of this conversion is done by special liver enzymes in the Cytochrome 450 family, specifically one numbered 2C19.
Prozac, and many other drugs, happens to inhibit this enzyme, meaning it makes it less effective at converting Plavix into its active form. Since only the active form does the work of preventing clotting, this can mean the effectiveness of Plavix is significantly reduced when taken with Prozac.
The interaction is significant enough that the FDA released a warning in 2009 that Plavix should not be taken with a number of medications, Prozac being one of them. However, there may be less awareness of this issue among doctors who don't regularly prescribe these medications.
I would start a conversation with this doctor about why they are insistent on you taking Prozac. Explain that you aren't comfortable with this, and ask what some possible alternatives are. Ultimately, the decision is yours though...don't allow any healthcare professional to pressure you into doing something you're very uncomfortable with.
