Drug Interaction Report

MONITOR: Coadministration of a tissue plasminogen activator with an angiotensin enzyme converting (ACE) inhibitor may increase the risk of angioedema and anaphylactoid reactions. The mechanism is unknown. Cases of orolingual angioedema have been associated with alteplase administration; many of these patients were also receiving ACE inhibitors.

MANAGEMENT: It is recommended to monitor patients for adverse reactions during concomitant therapy.

GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.

MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.