Drug interactions
Tenecteplase + Warfarin
Severity: Major
Tenecteplase and Warfarin: 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
Tenecteplase is a thrombolytic, and combining it with warfarin markedly increases the risk of serious bleeding, including intracranial hemorrhage. Therapeutic oral anticoagulation, especially with raised INR, is a major caution for thrombolysis.
What this interaction means in plain words
Tenecteplase and Warfarin 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.
Tenecteplase belongs to Cardiovascular; Warfarin belongs to Cardiovascular.
Why it happens
Additive pharmacodynamic effect: fibrinolysis combined with impaired vitamin K-dependent clotting factor synthesis.
What to do
Check INR before giving tenecteplase and avoid it if the INR is elevated beyond label limits. If given, monitor closely for bleeding and have reversal options ready.
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 Warfarin
- Defibrotide + Warfarin Contraindicated
- Ketorolac + Warfarin Contraindicated
- Abciximab + Warfarin Major
- Acetylsalicylic acid + Warfarin Major
- Adagrasib + Warfarin Major
- Amiodarone + Warfarin Major
Other interactions of Tenecteplase
- Alteplase + Tenecteplase Contraindicated
- Acetylsalicylic acid + Tenecteplase Major
- Apixaban + Tenecteplase Major
- Argatroban + Tenecteplase Major
- Dabigatran etexilate + Tenecteplase Major
- Dalteparin + Tenecteplase Major
Frequently asked questions
Can I take Tenecteplase with Warfarin?
MediHelp rates the interaction as major. Tenecteplase and Warfarin 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. Tenecteplase is a thrombolytic, and combining it with warfarin markedly increases the risk of serious bleeding, including intracranial hemorrhage. Therapeutic oral anticoagulation, especially with raised INR, is a major caution for thrombolysis.
How serious is the interaction between Tenecteplase and Warfarin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Check INR before giving tenecteplase and avoid it if the INR is elevated beyond label limits. If given, monitor closely for bleeding and have reversal options ready.
What other medicines interact with Warfarin?
MediHelp also lists interactions of Warfarin with, for example, Defibrotide, Ketorolac, Abciximab. The full list is on the Warfarin page.
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