Drug interactions
Alteplase + Ticagrelor
Severity: Major
Alteplase and Ticagrelor: major 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
Ticagrelor is a potent platelet inhibitor, and giving a thrombolytic on top of it increases the likelihood of major bleeding, including intracranial hemorrhage. The combination is used in some acute coronary settings but with clear added risk.
What this interaction means in plain words
Alteplase and Ticagrelor can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Alteplase belongs to Cardiovascular; Ticagrelor belongs to Cardiovascular.
Why it happens
Additive pharmacodynamic effect: reversible P2Y12 receptor blockade by ticagrelor combined with plasmin-mediated clot lysis by alteplase.
What to do
Confirm that thrombolysis is clearly indicated and monitor closely for bleeding, including neurological changes; avoid invasive procedures and arterial punctures where possible.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Alteplase
- Alteplase + Defibrotide Contraindicated
- Alteplase + Reteplase Contraindicated
- Alteplase + Tenecteplase Contraindicated
- Acetylsalicylic acid + Alteplase Major
- Alteplase + Apixaban Major
- Alteplase + Argatroban Major
Other interactions of Ticagrelor
- Abciximab + Ticagrelor Major
- Abrocitinib + Ticagrelor Major
- Acalabrutinib + Ticagrelor Major
Frequently asked questions
Can I take Alteplase with Ticagrelor?
MediHelp rates the interaction as major. Alteplase and Ticagrelor can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Ticagrelor is a potent platelet inhibitor, and giving a thrombolytic on top of it increases the likelihood of major bleeding, including intracranial hemorrhage. The combination is used in some acute coronary settings but with clear added risk.
How serious is the interaction between Alteplase and Ticagrelor?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Confirm that thrombolysis is clearly indicated and monitor closely for bleeding, including neurological changes; avoid invasive procedures and arterial punctures where possible.
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.
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