Alteplase

Also known as: rt-PA, Recombinant Tissuetype Plasminogen Activator

Drug #40

Alteplase is a fibrinolytic agent. Alteplase is a tissue plasminogen activator (t-PA) produced by recombinant DNA technology. It works to break up and dissolve blood clots which can block arteries. I is usde in fibrinolytic therapy of acute heart attack or pulmonary embolism and ischemic stroke. Alteplase is better than streptokinase and urokinase in dissolving older clots.

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Primary Characteristics

Alteplase is also known as rt-PA, Recombinant Tissuetype Plasminogen Activator.

It is of Natural origin and belongs to Polypeptide.

It belongs to Plasminogen Activator pharmacological group on the basis of mechanism of action and also classified in Thrombolytic Agent pharmacological group.

Molecular Weight: 65000 · Solubility in Water: soluble · Non-proprietary name: Alteplase.

Pharmacokinetics

Absorption: Alteplase has an oral bioavailability is 0.5% (±0.5%).

Distribution: Alteplase has a volume of distribution is 11 litre.

Elimination: it is metabolised via Hepatic, plasma half-life is 3-11 min, renal excretion is 80%.

Indications

Alteplase is primarily indicated in conditions like Acute ischaemic stroke, Myocardial infarction, Peripheral arterial thrombosis, Peripheral venousthrombosis, Pulmonary embolism, Stroke.

Contraindications

Alteplase is contraindicated in conditions like Peptic ulcer, Recent surgery or trauma, Susceptibility to internal bleeding, Menstruation.

Dosage

Alteplase's dosage details are as follows:

Dose	Single Dose	Frequency	Route	Instructions
Adult Dosage
10 mg	10 mg	—	IV	This is the dose for pulmonary embolism. Give this initial IV dose over 1-2 minutes. This dose should be followed by 90mg by intravenous infusion over 2 hours, maximum 1.5 mg/Kg in patients less than 65 Kg.
15 mg	15 mg	—	IV	This is the accelerated regimen for myocardial infarction. Initiate within 6 hours of symptom onset. This dose should be followed by 50mg by intravenous infusion over 30 minutes, then 35 mg over 60 minutes (total 100 mg over 90 minutes).
15 mg	15 mg	—	IV	This is the accelerated regimen for myocardial infarction for patients less then 65 Kg weight. This dose should be followed by 0.75mg/Kg by intravenous infusion over 30 minutes, then 0.5mg/Kg over 60 minutes (total 100 mg over 90 minutes).
15 mg	15 mg	—	IV	This is for myocardial infarction within 6-12 hours of symptom onset. This dose should be followed by 50mg by intravenous infusion over 60 minutes, then 4 infusions each of 10mg over 30 minutes (total 100 mg over 3 hours; maximum 1.5 mg/Kg in patients less than 65 Kg).
900 mcg/Kg	900 mcg/Kg	—	IV	This is the dose for acute stroke initiate within 4.5 hours of symptom onset. Infuse over 60 minutes (Maximum 90 mg); initial 10% dose by intraveous injection, remainder by IV infusion.
Paediatric Dosage (20kg)
0.75 mg/kg	0.75 mg/kg	—	Intra Venous	As Required
100 – 500 mcg/kg.hour	—	—	IV-Inf	For 3-6 hours; maximum 100 mg total daily dose; use ultrasound assessment to monitor effect before c
Neonatal Dosage (3kg)
100 – 500 mg/kg/hour	—	—	IV-Inf	It can be given for 3-6 hours and ultrasound assessment to moniter effect before considering a second cause of treatment.

Drug Interactions

Unknown3 interactions

Moderate1 interaction

Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Side Effects

Alteplase in overdosage may give rise to further complications which include Gingival tissue bleeding, Urinary tract bleeding.

Alteplase produces potentially life-threatening effects which include Hemorrhage , Hemorrhage. Careful monitoring is needed with proper medical management.

The signs and symptoms that are produced after acute overdosage of Alteplase are Bleeding .

Alteplase is known to cause more or less tolerable side effects which are usually transient. These include Hypersensitivity reactions, Hypotension , Vomiting .

Warnings / Precautions

Alteplase should be used with caution in patients with major surgry, organ biopsy or trauma within the past 10 days, cardiovascular disease, pregnancy, diabetic retinopathy. It should be used with extreme caution in conditions in which bleeding could be hazardous or difficult to control due to its location. If anaphylactic reaction occur during therapy, discontinue the infusion and manage the conditions accordingly. It is not recommended for patients over 80 years.

Interference in Pathology

Alteplase may interfere in the diagnosis of Measurement of plasma fibrinogen , Other Coagulation Tests .

Available Brands

None recorded.

Storage Conditions

Alteplase should be stored Inj.

Drug Classification

1.10.2 — Anticoagulants/Platelet deaggregators
2.12.5 — Anti-thrombotic drugs and myocardial infarction