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Drug Interactions between Cathflo Activase and garlic

This report displays the potential drug interactions for the following 2 drugs:

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Moderate

alteplase garlic

Applies to: Cathflo Activase (alteplase) and garlic

GENERALLY AVOID: Garlic may potentiate the effects of anticoagulants, platelet inhibitors and thrombolytic agents, possibly increasing the risk of bleeding. Garlic has been shown in some studies to have antithrombotic effects and may increase fibrinolysis, decrease platelet aggregation, and increase prothrombin time. Antiplatelet activity is present in garlic powder, aged garlic preparations, garlic oil, and fresh garlic (more so raw than when it is cooked). There have been isolated reports of bleeding complications associated with chronic, high dietary intake of garlic, as well as reports suggesting an interaction between warfarin and garlic resulting in increased INR.

MANAGEMENT: Patients should consult a healthcare provider before taking any herbal or alternative medicine. In general, consumption of garlic supplements and large amounts of garlic should preferably be avoided during use of coagulation-modifying agents. In patients who have used this herb extensively prior to receiving anticoagulation, antiplatelet or thrombolytic therapy, the potential for an interaction should be considered. Close clinical and laboratory observation for hematologic complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References

  1. Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
  2. Fugh-Berman A "Herb-drug interactions." Lancet 355 (2000): 134-8
  3. Heck AM, DeWitt BA, Lukes AL "Potential interactions between alternative therapies and warfarin." Am J Health Syst Pharm 57 (2000): 1221-7; quiz 1228-30
  4. Vaes LP, Chyka PA "Interactions of warfarin with garlic, ginger, or ginseng: nature of evidence." Ann Pharmacother 34 (2000): 1478-82
  5. Steiner M, Lin RS "Changes in platelet function and susceptibility of lipoproteins to oxidation associated with administration of aged garlic extract." J Cardiovasc Pharmacol 31 (1998): 904-8
  6. Chutani SK, Bordia A "The effect of fried versus raw garlic on fibrinolytic activity in man." Atherosclerosis 38 (1981): 417-21
  7. Kiesewetter H, Jung F, Jung EM, Mrowietz C, Kosciehlny J, Wenzel E "Effect of garlic on platelet aggregation in patients with increased risk of juvenile ischaemic attack." Eur J Clin Pharmacol 45 (1993): 333-6
  8. Legnani C, Frascaro M, Guazzaloca G, Ludovici S, Cesarano G, Coccheri S "Effects of a dried garlic preparation on fibrinolysis and platelet aggregation in healthy subjects." Arzneimittelforschung 43 (1993): 119-22
  9. Morris J, Burke V, Mori TA, Vandongen R, Beilin LJ "Effects of garlic extract on platelet aggregation: a randomized placebo-controlled double-blind study." Clin Exp Pharmacol Physiol 22 (1995): 414-7
  10. Izzo AA, Ernst E "Interactions between herbal medicines and prescribed drugs: a systematic review." Drugs 61 (2001): 2163-75
  11. Evans V "Herbs and the brain: friend or foe? The effects of ginkgo and garlic on warfarin use." J Neurosci Nurs 32 (2000): 229-32
  12. Apitz-Castro R, Escalante J, Vargas R, Jain MK "Ajoene, the antiplatelet principle of garlic, synergistically potentiates the antiaggregatory action of prostacyclin, forskolin, indomethacin and dypiridamole on human platelets." Thromb Res 42 (1986): 303-11
  13. Ackermann R, Mulrow C, et al. Agency for Healthcare Research and Quality, Lawrence V "Garlic: effects on cardiovascular risks and disease, protective effects against cancer, and clinical adverse effects. Evidence Report/Technology Assessment Number 20. AHRQ Publication No. 01-E023 http://www.ahrq.gov/clinics/garlicsum.htm" (2002):
  14. Burnham BE "Garlic as a possible risk for postoperative bleeding." Plast Reconstr Surg 95 (1995): 213
  15. German K, Kumar U, Blackford HN "Garlic and the risk of TURP bleeding." Br J Urol 76 (1996): 518
View all 15 references

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

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Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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