Drug Index

Alteplase

 
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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).


07/14/2019 06:41:22 Alteplase
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