Clopidogrel and Fluvoxamine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clopidogrel
Fluvoxamine
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced clopidogrel active metabolite exposure, reduced platelet inhibition and an increased risk of bleeding
Interaction Deep Dive
Clopidogrel is metabolized to its active metabolite by CYP2C19. Concomitant use of clopidogrel and fluvoxaMINE (strong CYP2C19 inhibitor) may reduce clopidogrel active metabolite exposure and reduced platelet inhibition1. Additionally, concomitant use may increase the risk of bleeding, as the release of serotonin by platelets is important for maintaining hemostasis 4. In a meta-analysis, there was a significant 11% increased risk of ischemic events when coadministered. Consider treatment with an SSRI that is not a CYP2C19 inhibitor 3.
Why it happens (mechanism)
Inhibition of CYP2C19-mediated metabolism of clopidogrel; unknown
Literature reports
1 report — tap to read
a) Initiation of clopidogrel in patients receiving a CYP2C19-inhibiting SSRI (n=9281; 97.5% FLUoxetine; 2.5% fluvoxaMINE) resulted in a small but significant 12% increased risk of any ischemic event (95% CI, 1.01 to 1.24) compared with non-CYP2C19-inhibiting SSRIs (n=44,278) in a propensity-score matched cohort study. CYP2C19-inhibiting SSRIs were also associated with a significant 18% increased risk of a stent procedure, and at 17% increased risk of PTCA. In patients 65 years or older, there was a nonsignificant 22% increased risk of any ischemic event, a significant 39% increased risk of stenting, and a significant 38% increased risk of PTCA 2. Initiation of a CYP2C19-inhibiting SSRI (n=2350; 98% FLUoxetine; 2% fluvoxaMINE) in patients receiving clopidogrel resulted in a nonsignificant 7% (95% CI, 0.82 to 1.4) increased risk of any ischemic event compared with non-CYP2C19-inhibiting SSRIs (n=16,115) in a propensity-score matched cohort study. In a meta-analysis of pooled results regardless of the order of drug initiation, there was a significant 11% (95% CI, 1.01 to 1.22) increased risk of any ischemic event and no significant difference in the composite bleeding outcome 3.
Common questions
Can I take Clopidogrel and Fluvoxamine together?
Reduced clopidogrel active metabolite exposure, reduced platelet inhibition and an increased risk of bleeding Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clopidogrel and Fluvoxamine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Clopidogrel or Fluvoxamine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (4)
- Product Information: PLAVIX(R) oral tablets, clopidogrel bisulfate oral tablets. sanofi-aventis US LLC (per FDA), Bridgewater, NJ, 2022. DailyMed
- Bykov K, Schneeweiss S, Donneyong MM, et al: Impact of an interaction between clopidogrel and selective serotonin reuptake inhibitors. Am J Cardiol 2017; 119(4):651-657. PubMed
- Bykov K, Schneeweiss S, Glynn RJ, et al: Updating the evidence of the interaction between clopidogrel and CYP2C19-inhibiting selective serotonin reuptake inhibitors: a cohort study and meta-analysis. Drug Saf 2017; 40(10):923-932. PubMed
- Product Information: LUVOX CR(R) oral extended release capsules, fluvoxamine maleate oral extended release capsules. Jazz Pharmaceuticals, Inc. (per FDA), Palo Alto, CA, 2014. DailyMed
Keep reading about Clopidogrel
Keep reading about Fluvoxamine
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