Drug Index


Synonyms :

Activase, rt-PA, TPA

Mechanism :

Alteplase is a recombinant human tissue-type plasminogen activator (t-PA); it produces local fibrinolysis by converting plasminogen to plasmin; plasmin in turn degrades fibrin and fibrinogen.

Indication :

  • Central venous catheter occlusion.

Contraindications :

Hypersensitivity, Active internal haemorrhage or history of intracranial hemorrhage, bleeding diathesis, Ischemic Stroke (within 3 months), Recent GI or GU bleeding, Hypertension: Systolic BP >175 mm Hg and/or diastolic BP >110 mm Hg, Acute pericarditis, Subacute bacterial endocarditis, High likelihood of left heart thrombus (e.g., mitral stenosis with atrial fibrillation).

Dosing :

<30 kg: Instill a volume equal to 110% of the internal lumen volume of the catheter. Maximum dose: 2 mg in 2 ml. The dose can be repeated in 2 hours if catheter remains occluded.
>30 kg: 2 mg instilled into the occluded catheter (reconstituted to a 1 mg/1 ml concentration).
Maximum dose: 2 mg/dose. The dose can be repeated in 2 hours if catheter remains occluded.
Use with caution in severe renal and hepatic impairment.

Adverse Effect :

Sepsis, shock, re-occlusion, idioventricular rhythm, pulmonary edema, arterial embolism, hypotension, DVT, pulmonary embolism, nausea, vomiting, hemorrhage, hypersensitivity reactions.

Interaction :

Prothrombin: The use of alteplase with prothrombin complex concentrates (human) is contraindicated because of pharmacodynamic synergism.
Apixaban and Alteplase: Both significantly increase anti coagulation and therefore should not be used together.
Ceftaroline: Increases the effects of alteplase (mild effect).

Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Dose as in normal renal function
<10Dose as in normal renal function

Dose in Patients undergoing Renal Replacement Therapies
CAPDNot dialysed. Dose as in normal renal function
HDNot dialysed. Dose as in normal renal function
HDF/High fluxUnknown dialysability. Dose as in normal renal function
CAV/VVHDNot dialysed. Dose as in normal renal function

Hepatic Dose :

No dosage adjustments are recommended. Use with caution
03/20/2024 21:11:16 Alteplase
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