Interactions of thrombolytic agents with other cardiovascular drugs
Alteplase, Anistreplase, Reteplase, Streptokinase, Tenecteplase, Urokinase
| Drug | Pharmacodynamic interactions | Pharmacokinetic interactions | Cautions |
|---|---|---|---|
| Angiotensin enzyme converting inhibitors | Increase the risk of angioedema and anaphylactoid reactions | ||
| - Anticoagulants - Antiplatelet agents - Dextrans - Dipyridamole - NSAIDs - Prostacyclin - Thrombolytics - Vitamin K antagonists | Increase the risk of bleeding | Careful monitoring for bleeding (especially at arterial puncture sites) is recommended Heparin and aspirin are given concomitantly with and following the administration of reteplase in patients with AMI | |
| Chemotherapy drugs:
- Acalabrutinib - Cabozantinib - Dasatinib - Ibritumomab - Ibrutinib - Omacetaxine - Panabinostat - Ponatinib - Ramucirumab - Regorafenib - Tositumomab | Many of these drugs produce thrombocytopenia and increase the bleeding risk | Monitor the patient | |
| Clomipramine | Skin and mucous membrane bleeding has been reported with clomipramine | Monitor the patient | |
| Deferasirox | Increase the risk of gastrointestinal ulcers and bleeding | Physicians and patients should remain alert for signs and symptoms of gastrointestinal ulceration and hemorrhage | |
| Ginkgo biloba | It inhibits platelet aggregation. The combination increases the risk of bleeding | Monitor the patient | |
| HIV protease inhibitors:
- Tipranavir | Monitor the patient | ||
| Inotersen | Produces thrombocytopenia and increases the risk of bleeding | Monitor the patient | |
| Nitroglycerin | It appears to impair thrombolytic effects of t-PA | When both drugs are combined, the blood levels and effects of alteplase may decrease | Monitor the patient |
| Omega-3 fatty acids | Decrease platelet activity and aggregation and may prolong the bleeding time | Patients should be monitored due to potential increased risk of bleeding | |
| Pentoxifylline | Increases the risk of bleeding | The concomitant administration should be undertaken with caution | |
| SSRIs:
- Paroxetine - Sertraline - Venlafaxine | Drugs that inhibit serotonin uptake reduce platelet function and increase the risk of bleeding | SSRIs should be used with caution |
Abbreviations
AMI: Acute myocardial infarction
NSAIDs: nonsteroidal anti-inflammatory drugs
SSRIs: selective serotonin reuptake inhibitors
t-PA: Tissue plasminogen activator