Drug General Information (ID: DDIMNBJCWH)
Drug Name			Alteplase		Drug Info		Ramucirumab		Drug Info
Drug Type		Protein/peptide				Monoclonal antibody
Therapeutic Class		Thrombolytics				Vegf/Vegfr Inhibitors

Mechanism of Alteplase-Ramucirumab Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Alteplase				Ramucirumab
Mechanism		Risk of bleeding Thrombolytic agent				Risk of bleeding Antiplatelet/anticoagulant 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 Alteplase and Ramucirumab

Recommended Action
Management		Concomitant use of ramucirumab and medications that interfere with platelet function or coagulation should be approached cautiously. Close clinical and laboratory observation for bleeding 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. Ramucirumab should be permanently discontinued in patients who experience severe bleeding.

References
1	Product Information. Cyramza (ramucirumab). Eli Lilly and Company, Indianapolis, IN.