Alteplase

Anticoagulant/Antiplatelet · Fibrinolytic

Indications

Acute myocardial infarction, pulmonary embolism, acute ischaemic stroke.

Dosage

Adults: Myocardial infarction: Accelerated regimen (initiated within 6 hr of symptom onset): 15 mg by IV inj, followed by IV infusion of 50 mg over 30 min, then 35 mg over 60 min (total dose 100 mg over 90 min). In patients < 65 kg, 15 mg by IV inj, followed by IV infusion of 0.75 mg/kg over 30 min, then 0.5 mg/kg over 60 min (max total dose 100 mg over 90 min). Myocardial infarction, initiated within 6-12 hr of symptom onset: 10 mg by IV inj, followed by IV infusion of 50 mg/kg over 60 min, then 4 infusions each of 10 mg over 30 min (total dose 100 mg over 3 hr; max 1.5 mg/kg in patients less than 65 kg). Pulmonary Embolism: 10 mg by IV inj over 1-2 min, followed by IV infusion of 90 mg over 2 hr; max 1.5 mg/kg in patients less than 65 kg. Acute stroke: (Treatment must begin within 3 hr of symptom onset): IV over 60 min, 900 mcg/kg (max 90 mg); initial 10% of dose by IV injection,…

Administration

IV: Acute MI: Accelerated infusion: Bolus dose may be prepared by one of three methods: 1. Removal of 15 mL reconstituted (1 mg/mL) solution from vial. 2. Removal of 15 mL from a port on the infusion line after priming. 3. Programming an infusion pump to deliver a 15 mL bolus at the initiation of infusion. Remaining dose may be administered as follows: 50 mg vial: Either PVC bag or glass vial and infusion set. 100 mg vial: Insert spike end of the infusion set through the same puncture site created by transfer device and infuse from vial. Reconstitution: 50 mg/100 mg vial: Use accompanying diluent (50 mL/ 100 mL sterile water for injection); do not shake; final concentration: 1 mg/mL. Compatibility: Stable in NS, SWFI. Stability: Store lyophilized alteplase at controlled room temperature not to exceed 30°C (86°F) or under refrigeration 2°C-8°C (36° F-46°F). During extended storage,…

Adverse Effects

Risk of cerebral bleeding, nausea, vomiting, reperfusion arrhythmias and recurrent ischaemia and angina, hypotension, back pain, fever, convulsion.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Recent haemorrhage, trauma, surgery, coagulation defects, bleeding diatheses, aortic dissection, aneurysm, coma, history of cerebrovascular disease, peptic ulceration, heavy vaginal bleeding, severe hypertension, active pulmonary disease, acute pancreatitis, pericarditis, bacterial endocarditis and oesophageal varices. Acute stroke, convulsion accompanying stroke, history of stroke in patients with diabetes, stroke in last 3 months, hypoglycaemia, hyperglycaemia. Precautions: Acute stroke, monitor for intracranial haemorrhage, monitor blood pressure. Use with caution if there is risk of bleeding, external chest compression, elderly, hypertension.

Advice to Patient

Immediately report bleeding, including from the nose or gums. To reduce the risk of injury and bleeding, take strict bed rest and limit physical activity. Use electric razor and soft toothbrush. Be cautious while using knives, needles or sharp things. To stop bleeding, apply pressure to the bleeding spot until bleeding stops completely. Contact prescriber if there is acute headache; joint pain; chest pain; unusual bruising or bleeding; blood in urine, stool or vomit; bleeding in gums; vision changes or respiratory difficulty.

Brands with this active ingredient

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Always consult a pharmacist or doctor.