Benazepril and Alteplase, Recombinant: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Benazepril
Alteplase, Recombinant
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
An increased risk of orolingual angioedema
Interaction Deep Dive
Use caution when administering alteplase to patients who take ACE inhibitors. An increased risk of orolingual angioedema has been observed in patients with acute ischemic stroke being treated with alteplase and receiving concomitant ACE inhibitors234. In case reports, angioedema occurred up to 2 hours after alteplase infusion. Patients receiving alteplase infusion should be monitored closely during and for several hours after infusion for signs of orolingual angioedema. Appropriate therapy should be initiated (ie, antihistamines, steroids or epinephrine) if orolingual angioedema occurs and discontinuation of alteplase infusion should be considered 1.
Why it happens (mechanism)
Increase in bradykinin production by alteplase; decrease in bradykinin breakdown by ACE inhibitors
Literature reports
3 reports — tap to read
a) A 58-year-old male receiving combination benazepril/amlodipine developed orolingual angioedema within 5 minutes of completing intravenous alteplase treatment for acute stroke. Head CT, erythrocyte sedimentation rate, immunoglobulin E, and CBC with differential were unremarkable. Anaphylactic reaction was not likely as the airway was not compromised and hemodynamic parameters were stable. The patient was treated with dexamethasone and a histamine antagonist and symptoms resolved completely over the next 48 hours 2.
b) In a prospective study of patients who received alteplase for stroke (n=120), the overall incidence of orolingual angioedema was 1.7% (n=2/120; 95% confidence interval (CI), 0.2% to 5.9%) with a 5% (n=1/19) incidence in patients receiving concurrent ACE inhibitors compared with a 1% (n=1/101) incidence in patients not receiving ACE inhibitors (p=0.1). In both patients who developed orolingual angioedema, it occurred bilaterally and within 30 minutes after alteplase infusion. In the patient receiving a concurrent ACE inhibitor, the orolingual angioedema was severe. CT findings excluded the possibility of lingual hematoma, and both patients had infarction involving the insular region. Both patients were treated with steroids and antihistamines and symptoms resolved gradually. Another study of stroke patients with alteplase-associated angioedema and concurrent ACE inhibitor use was evaluated. Among both studies, an increased risk was revealed for alteplase-induced angioedema in patients receiving ACE inhibitors (odds ratio, 37; 95% CI, 8 to 171; p less than 0.001) 3.
c) In a prospective study of patients who received alteplase for acute ischemic stroke (n=176), the overall incidence of orolingual angioedema was 5.1% (n=9/176; 95% confidence interval (CI), 2.3% to 9.5%). Among the patients who developed orolingual angioedema, 7 patients were receiving an ACE inhibitor (lisinopril, n=4; cilazapril, n=1; enalapril, n=1; ramipril, n=1), resulting in a relative risk (RR) of 13.6 (95% CI, 3 to 62.7) for the development of angioedema in patients receiving ACE inhibitors. In most cases, the angioedema was mild, unilateral, and developed contralaterally to the ischemic hemisphere. Patients were treated with histamine antagonists and steroids and symptoms resolved over 1 to 24 hours. Alberta Stroke Program Early CT Scale (ASPECTS) score analysis also revealed a higher risk (RR 6.4 (95% CI, 1.4 to 30) of orolingual angioedema for patients with infarction involving the insula and anterior frontal cortex regions 4.
Common questions
Can I take Benazepril and Alteplase, Recombinant together?
An increased risk of orolingual angioedema Always confirm with your pharmacist or prescriber before making any change.
How serious is the Benazepril and Alteplase, Recombinant interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Benazepril or Alteplase, Recombinant need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (4)
- Product Information: ACTIVASE(R) IV injection, alteplase IV injection. Genentech,Inc, South San Fransisco, CA, 2005.
- Rafii MS, Koenig M, & Ziai WC: Orolingual angioedema associated with ACE inhibitor use after rtPA treatment of acute stroke. Neurology 2005; 65(12):1906-. PubMed
- Engelter ST, Fluri F, Buitrago-Tellez C, et al: Life-threatening orolingual angioedema during thrombolysis in acute ischemic stroke. J Neurol 2005; 252(10):1167-1170. PubMed
- Hill MD, Lye T, Moss H, et al: Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke. Neurology 2003; 60(9):1525-1527. PubMed
Keep reading about Benazepril
Keep reading about Alteplase, Recombinant
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