ACTILYSE
ALTEPLASE · by MARTIN DOW MARKER
Composition
Inj: Alteplase 50 mg Powder and solvent for solution for injection
Indications & Dosage
Acute myocardial infarction, accelerated regimen: BY IV INJ AND INF: Adult (body-weight up to 65 kg): Initially 15 mg, to be initiated within 6 hrs of symptom onset, followed by (by IV INF) 0.75 mg/kg, to be given over 30 minutes, then (by IV INF) 0.5 mg/kg, to be given over 60 minutes, max. total dose of 100 mg administered over 90 minutes Adult (body-weight 65 kg and above): Initially 15 mg, to be initiated within 6 hrs of symptom onset, followed by (by IVINF) 50 mg, to be given over 30 minutes, then (by IV INF) 35 mg, to be given over 60 minutes, max. total dose of 100 mg administered over 90 minutes Acute myocardial infarction: BY IV INJ AND INF: Adult: Initially 10 mg, to be initiated within 6–12 hrs of symptom onset, followed by (by IV INF) 50 mg, to be given over 60 minutes, then (by IV INF) 10 mg for 4 INFs, each 10 mg INF dose to be given over 30 minutes, total dose of 100 mg over 3 hrs; max. 1.5 mg/kg in patients less than 65 kg. Pulmonary embolism: BY IV INJ AND INF: Adult: Initially 10 mg, to be given over 1–2 minutes, followed by (by IV INF) 90 mg, to be given over 2 hours, max. 1.5 mg/kg in patients less than 65 kg. Acute ischaemic stroke (under specialist neurology physician only): BY IV INJ AND INF: Adult 18–79 yrs: Initially 900 mcg/kg (max. per dose 90 mg), treatment must begin within 4.5 hrs of symptom onset, to be given over 60 minutes, the initial 10% of dose is to be administered by IV injection and the remainder by IV INF.
Administration
For IV infusion give intermittently in Sodium chloride 0.9%; dissolve in water for injections to a concentration of 1 mg/ml or 2 mg/ml and infuse intravenously; alternatively dilute the solution further in the infusion fluid to a concentration of not less than 200 mcg/ml; not to be infused in glucose solution.
Contraindications
Recent delivery, Convulsion accompanying stroke, history of stroke in patients with diabetes, hyperglycaemia, hypoglycaemia, severe stroke, stroke in last 3 months
Precautions
Acute stroke, Monitor for intracranial haemorrhage, and monitor blood pressure (antihypertensive recommended if systolic above 180 mmHg or diastolic above 105 mmHg). Elderly, risk of bleeding, chest compression Obtain haemostatic status of patient before starting therapy. Followup with anticoagulant therapy. See literature.
Interactions
Anticoagulants, drugs affecting platelet function.
Pregnancy
Not recommended
Lactation
Caution advised or effect undetermined
Side Effects
Haemorrhage, Haemothorax. Rare: Agitation, confusion, delirium, depression, epilepsy, psychosis, speech disorder Brain oedema(caused by reperfusion)