Drug General Information (ID: DDIHYKFB48)
Drug Name			Anistreplase		Drug Info		Ginger		Drug Info
Drug Type		Protein/peptide				Natural product
Therapeutic Class		Thrombolytics				Herbal Products

Mechanism of Anistreplase-Ginger Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Anistreplase				Ginger
Mechanism		Risk of bleeding Thrombolytic agent				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 Anistreplase and Ginger

Recommended Action
Management		Patients should consult a healthcare provider before taking any herbal or alternative medicine. In patients who have used ginger and ginger supplements 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	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. [PMID: 10902065]
2	Jiang X, Williams KM, Liauw WS, et al. "Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects." Br J Clin Pharmacol 59 (2005): 425-32. [PMID: 15801937]
3	Kruth P, Brosi E, Fux R, Morike K, Gleiter CH "Ginger-associated overanticoagulation by phenprocoumon." Ann Pharmacother 38 (2004): 257-60. [PMID: 14742762]
4	Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11. [PMID: 9818800]
5	Vaes LP, Chyka PA "Interactions of warfarin with garlic, ginger, or ginseng: nature of evidence." Ann Pharmacother 34 (2000): 1478-82. [PMID: 11144706]