Thrombolytic agents

Drug interaction

Interactions of thrombolytic agents with other cardiovascular drugs

Alteplase, Anistreplase, Reteplase, Streptokinase, Tenecteplase, Urokinase

DrugPharmacodynamic interactionsPharmacokinetic interactionsCautions
Angiotensin enzyme converting inhibitorsIncrease the risk of angioedema and anaphylactoid reactions
- Anticoagulants
- Antiplatelet agents
- Dextrans
- Dipyridamole
- Prostacyclin
- Thrombolytics
- Vitamin K antagonists
Increase the risk of bleedingCareful 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 riskMonitor the patient
ClomipramineSkin and mucous membrane bleeding has been reported with clomipramineMonitor the patient
DeferasiroxIncrease the risk of gastrointestinal ulcers and bleedingPhysicians and patients should remain alert for signs and symptoms of gastrointestinal ulceration and hemorrhage
Ginkgo bilobaIt inhibits platelet aggregation. The combination increases the risk of bleedingMonitor the patient
HIV protease inhibitors:
- Tipranavir
Monitor the patient
InotersenProduces thrombocytopenia and increases the risk of bleedingMonitor the patient
NitroglycerinIt appears to impair thrombolytic effects of t-PAWhen both drugs are combined, the blood levels and effects of alteplase may decreaseMonitor the patient
Omega-3 fatty acids Decrease platelet activity and aggregation and may prolong the bleeding timePatients should be monitored due to potential increased risk of bleeding
PentoxifyllineIncreases the risk of bleedingThe concomitant administration should be undertaken with caution
- Paroxetine
- Sertraline
- Venlafaxine
Drugs that inhibit serotonin uptake reduce platelet function and increase the risk of bleedingSSRIs should be used with caution


AMI: Acute myocardial infarction
NSAIDs: nonsteroidal anti-inflammatory drugs
SSRIs: selective serotonin reuptake inhibitors
t-PA: Tissue plasminogen activator