Drug Interactions of Fibrinolytics (Part 1):

Drug Interactions of Recombinant Tissue Plasminogen Activators (rtPA):

More Presentations from Naina Mohamed, PhD

©   Tissue Plasminogen Activator (tPA) is an enzyme found in blood and tissues.

©   The major physiological function of Tissue Plasminogen Activator (tPA) is to generate plasmin which can dissolve blood clots inside the blood vessels. 

©   Tissue Plasminogen Activator (tPA) is synthesized mainly in vascular endothelial cells and is secreted into the plasma continuously.

©   Recombinant tissue plasminogen activators (rtPA) include Alteplase, Reteplase and Tenecteplase.

•        The risk of Orolingual angioedema might be increased by the concomitant use of Alteplase and ACE inhibitors (Captopril, Lisinopril, Perindopril, etc).

•       Concurrent use of Alteplase and Nitroglycerin (GTN) results in Less coronary artery reperfusion, Longer time to reperfusion, and more coronary artery Reocclusion

•       It is Contraindicated to use Fibrinolytics and Defibrotide concomitantly.

•       Drugs increasing the risk of Fibrinolytics associated Bleeding include…

o  Anticoagulants (Warfarin, Heparin, Enoxaparin, Dabigatran, etc)

o  Antiplatelet agents (Aspirin, Clopidogrel, etc)

o  Pentosan Polysulfate Sodium

•       Herbs increasing the risk of Fibrinolytics associated Bleeding include…

o  Fenugreek

o  Garlic

o  Ginkgo

o  Evening Primrose Oil

o  Clove Oil

o  Anise

o  Turmeric (Curcumin)

o  Licorice

o  Asafetida

o  Capsicum (Capsaicin)

o  Celery

o  Kava

o  Cat's claw

o  Medowsweet

o  Feverfew

o  Tan-shen

©   Drug interactions can result in significant morbidity and mortality and thus minimizing the risk for drug interactions should be a goal in drug therapy.

©   The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

©   Pharmacists can play a crucial role in identifying possible drug interactions by asking patients on Anticoagulants about their herbal and other alternative medicine product use.

Clinically Important Drug Interactions of Anticoagulants:

   

More Presentations from Naina Mohamed, PhD

Anticoagulants are the drugs affecting blood coagulation factors and used to prevent harmful blood clots, which can cause serious conditions like Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), or a Stroke.

©   Classification of Anticoagulants:

o  Coumarins (Oral)

·      Warfarin

·      Acenocoumarol

·      Dicoumarol

·      Ethyl biscoumacetate

·      Phenprocoumon

o  Indandiones (Oral)

·      Phenindione

·      Fluindione

o  Factor Xa inhibitors

·      Fondaparinux sodium

·      Rivaroxaban (Oral)

o  Heparin

o  Low Molecular Weight Heparins (LMWH)

·      Enoxaparin

·      Dalteparin

·      Tinzaparin

·      Bemiparin

·      Certoparin

·      Nadroparin

·      Parnoparin

·      Reviparin

o  Heparinoids

·      Danaparoid

·      Dermatan sulphate

·      Pentosan polysulfate

·      Suleparoid, Sulodexide

o  Direct Thrombin inhibitors

·      Hirudins - Bivalirudin, Desirudin, Lepirudin

·      Synthetic Thrombin Inhibitors – Argotroban

·      Dabigatran etexilate (Oral)

©   Contraindicated Anticoagulant Combinations:

o  Antithrombotics  + Defibrotide

o  Heparin + Telavancin or Oritavancin

o  Dabigatran + Itraconazole or Ketoconazole

 ©   Drugs increasing the risk of Anticoagulants associated Bleeding:

o  NSAIDs (Ibuprofen, Diclofenac, Naproxen, etc)

o  Selective serotonin reuptake inhibitors (SSRIs) (Fluvoxamine, Paroxetine, Vortioxetine,  Escitalopram, Sertraline, Nefazodone, vilazodone)

o  Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) (Venlafaxine, Desvenlafaxine, Duloxetine, Milnacipran, Levomilnacipran, Sibutramine)

o  Antiplatelet agents (Aspirin, Clopidogrel, Ticagrelor, etc)

o  Fibrinolytics (Alteplase, Retaplase, Tenecteplase, Streptokinase, Urokinase)

o  Fenofibrate

o  Orlistat

 ©   Dietary Supplements reducing the efficacy of Anticoagulants:

o  Coenzyme Q10

o  St.John's Wort

 ©   Foods and Herbs elevating the risk of Anticoagulants associated Bleeding:

o  Fenugreek

o  Ginger

o  Anise

o  Clove Oil

o  Asafetida

o  Capsaicin

o  Evening primrose oil

o  Licorice

o  Celery

o  Ginkgo

o  Garlic

o  Papaya

o  Chamomile (Matricaria chamomilla)

©   TIPS for patients on Anticoagulants:

o  Do not double the dose to compensate a missed one.

o  Do not forget to discuss with your surgeon or dentist about the regular use of Anticoagulant prior to any surgery.

o  Talk to your Physician or Pharmacist before taking any other medications, including prescription and OTC (Over-The-Counter) medicines.

o  Contact your doctor if you develop severe diarrhea, an infection or a fever.

o  Seek immediate medical advice if there is signs of bleeding such as blood in your stools or urine, nose-bleeds, bleeding gums, excessive menstrual bleeding or excessive bruising.

o  Be careful with knives and try to minimize the risk of falling.

o  Always adhere to the prescribed dosage schedule.

o  Wear or carry an identification stating that You are on Anticoagulant.

©   Drug interactions can result in significant morbidity and mortality and thus minimizing the risk for drug interactions should be a goal in drug therapy.

©   The patients with clotting disorders should bring a list of all of the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

©   The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

©   If possible, the patients are recommended to fill all their prescriptions at one pharmacy.

©   Pharmacists can play a crucial role in identifying possible drug interactions by asking patients on Anticoagulants about their herbal and other alternative medicine product use.