Drug General Information (ID: DDIPR5G4YE)
Drug Name			Reteplase		Drug Info		Hemin		Drug Info
Drug Type		Protein/peptide				Small molecule
Therapeutic Class		Thrombolytics				Heme Iron Supplement

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

Recommended Action
Management		The use of hemin with concurrent anticoagulant therapy should be avoided. Caution is advised if hemin is used in combination with other drugs that affect hemostasis such as platelet inhibitors, thrombin inhibitors, thrombolytic agents, or agents that commonly cause thrombocytopenia. 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	Product Information. Panhematin (hemin). Recordati Rare Diseases Inc, Lebanon, NJ.