Drug General Information (ID: DDIEI6Q4RM)
Drug Name			Lepirudin		Drug Info		Tolmetin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antithrombotic Agents				Antiinflammatory Agents
Structure

Mechanism of Lepirudin-Tolmetin Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Lepirudin				Tolmetin
Mechanism		Risk of bleeding Anticoagulant				Risk of bleeding Antiplatelet effects
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Lepirudin and Tolmetin

Recommended Action
Management		Until further data are available, products containing NSAIDs, especially if given chronically or in high dosages, should preferably be avoided in patients receiving thrombin inhibitors. Close clinical and laboratory observation for bleeding complications is recommended if concurrent therapy is necessary.

References
1	Product Information. Acova (argatroban) SmithKline Beecham, Philadelphia, PA.
2	Product Information. Angiomax (bivalirudin) The Medicines Compny, Cambridge, MA.
3	Product Information. Refludan (lepirudin). Hoechst Marion-Roussel Inc, Kansas City, MO.