Alteplase is synthesized by recombinant DNA technology and is available in the U.S. under the brand name Activase and Cathflo Activase. The drug dissolves blood clots in catheters placed in large blood vessels. It is administered soon after symptoms of a heart attack and a stroke and when blood clots are suspected to have formed in the lungs (Pulmonary Embolism).
It is a drug of the therapeutic class, thrombolytic and the pharmacologic class, tissue plasminogen activator. It is a white to off-white, sterile, freeze-dried powder used to make a solution for intravenous administration. It is administered only by a trained healthcare professional.
All of the above are by no means all the unwanted effects that may occur after the use of Alteplase. A doctor should be informed of all the side effects experienced for proper medical advice. Adverse effects can also be reported to the FDA on 1-800-FDA-1088.
Alteplase should be administered as soon as is possible after symptoms are seen but at least within 3 hours of the onset of symptoms.
The maximum dose given should not exceed 90mg, though the recommended dosage is 0.9mg/Kg. 10% of the entire dose should be administered within 1 minute as the initial intravenous bolus. The remaining drug should be given within 60 minutes.
Blood pressure should frequently be measured and monitored during this treatment.
Alteplase should be administered as soon as symptoms are observed. Dosage is determined by the weight of the patient but must not exceed 100mg, irrespective of the selected administration regime. For this condition, the drug can be administered in two ways:
For patients greater than or equal to 67kgs in weight, the first intravenous bolus of 15mg should be administered as soon as possible. This should be followed by 50mg in the next 30 minutes and 35mg within the next 60 minutes.
For patients less or equal to 67kgs of body weight, the first intravenous bolus should be 15mg administered as soon as possible. The second should be at a ratio of 0.75mg/kg, delivered within 30 minutes and the third at a rate of 0.5mg/kg administered within 60 minutes.
For patients greater than 65kg, the dosage should be 100mg. 60mg should be administered in the first hour, with 6-10mg administered as a bolus. 20mg should be administered in the second hour and the remainder in the third hour.
Patients who weigh less than 65kgs should have a dose of 1.25mg/kg administered over 3 hours. A bolus should be administered first at the ratio of 0.075mg/kg. During the rest of the first hour, the patient should get 0.675mg/kg and 0.25mg/kg in the second and third hours.
Using the intravenous infusion method of administration, 100mg of the drug should be given over a two hour period.
No data is available for the dose adjustments required when administering Alteplase for patients with liver or renal impairments and those undergoing dialysis.
Alteplase interacts with 226 drugs (899 generic and brand names). 92 generic and brand names, which are 40 distinct drugs, have major interactions with alteplase. Of 801 generic and brand names, 180 different drugs have moderate interactions with alteplase. 6 drugs have minor interactions with alteplase.
Alteplase should not be used if a patient has any one of the following medical conditions:
If a patient has any one of the following, the chances of severe bleeding are increased:
Patients with a history of high cholesterol, deep venous thrombosis (blood clots in the leg) or a catheter infection have an increased risk of severe side effects.
Alteplase may also make heart rhythm problems worse.
The patient should inform their doctor of any allergies to alteplase, or any other drugs.
The doctor should also be informed of any medical conditions that the patient may be suffering as well as therapies they may be undergoing. All OTC drugs, vitamins, mineral supplements and any other natural products that the patient may be using should also be listed for the doctor. This will help the doctor determine the safety of giving this medication.
There is the possibility of severe bleeding in some people after using this drug. The advice of the patient’s doctor should be followed to help prevent any serious blood loss. Movement should also be reduced to a minimum and the patient should only get out of bed when informed it is safe to do so by his or her doctor.
Animal studies have shown adverse effects to the fetus after administering alteplase, or such studies have not been done. There are no adequate, well-controlled studies on pregnant women.
There are no adequate studies done on breastfeeding women to determine if this drug is passed in milk and if it poses a risk to a nursing infant. Most medicines are passed into human milk. The potential benefits of this drug to nursing women should be weighed against the dangers it poses to the child.
Alteplase should be stored at room temperature not exceeding 30 degrees C (86 degrees F) or under refrigeration between 2-8 degrees C (36-46 degrees F).
It should be protected from excessive exposure to light. When it is reconstituted, it must be used within 8 hours, and any unused portion discarded.
The expiry date is always stamped on the vial, and it should not be used after this.
Alteplase is useful for the conditions it is indicated for. However, after administration of this drug, the patient runs a risk of internal as well as external bleeding. The patient should be on the lookout for signs that might indicate bleeding, and a doctor notified immediately if any symptoms appear. Any other side effects that the patient experiences, as well health issues they may be suffering or begin to suffer from, must also be reported to the doctor.
The patient must not attempt to medicate themselves especially when they begin to experience adverse reactions. A doctor must be notified of all products the patient takes including natural products which might otherwise be deemed safe. Only a doctor can determine all possible interactions and assess safety of use.
All the information available on Alteplase is not contained here. The preceding information must be used for general purposes only and must not replace the advice of a doctor.