Drug interactions
Alteplase + Nitroglycerin rectal
Severity: Moderate
Alteplase and Nitroglycerin rectal: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Intravenous nitroglycerin has been reported to lower plasma alteplase levels and reduce its thrombolytic effect, possibly by increasing hepatic blood flow and clearance. Rectal nitroglycerin has lower and less predictable systemic exposure, so the effect is likely smaller.
What this interaction means in plain words
Alteplase and Nitroglycerin rectal can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Nitroglycerin may increase hepatic blood flow and enhance alteplase clearance, lowering its plasma concentration.
What to do
Use nitroglycerin when clinically needed, and monitor for reperfusion and clinical response to alteplase. Note that other indicated measures should not be withheld.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to see why Alteplase and Nitroglycerin rectal interact, what to do about it, and the sources.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 14 days on the web. No card needed.
Other interactions of Alteplase
- Alteplase + Defibrotide Contraindicated
- Alteplase + Reteplase Contraindicated
- Alteplase + Tenecteplase Contraindicated
- Acetylsalicylic acid + Alteplase Major
- Alteplase + Apixaban Major
- Alteplase + Argatroban Major
Frequently asked questions
Can I take Alteplase with Nitroglycerin rectal?
MediHelp rates the interaction as moderate. Alteplase and Nitroglycerin rectal can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Intravenous nitroglycerin has been reported to lower plasma alteplase levels and reduce its thrombolytic effect, possibly by increasing hepatic blood flow and clearance. Rectal nitroglycerin has lower and less predictable systemic exposure, so the effect is likely smaller.
How serious is the interaction between Alteplase and Nitroglycerin rectal?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use nitroglycerin when clinically needed, and monitor for reperfusion and clinical response to alteplase. Note that other indicated measures should not be withheld.
What other medicines interact with Alteplase?
MediHelp also lists interactions of Alteplase with, for example, Defibrotide, Reteplase, Tenecteplase. The full list is on the Alteplase page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
