{"id":1623,"date":"2023-06-25T17:28:42","date_gmt":"2023-06-25T17:28:42","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/alteplase\/"},"modified":"2023-06-25T19:59:09","modified_gmt":"2023-06-25T19:59:09","slug":"alteplase","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/alteplase\/","title":{"rendered":"Alteplase"},"content":{"rendered":"

<\/p>\n

Alteplase<\/h1>\n

CLINICAL USE<\/h3>\n

Fibrinolytic drug:<\/p>\n

  • Acute myocardial infarction<\/li>\n
  • Pulmonary embolism<\/li>\n
  • Acute ischaemic stroke<\/li>\n
  • To unblock dialysis lines (unlicensedindication)
    \n

    DOSE IN NORMAL RENAL FUNCTION<\/h3>\n<\/li>\n
  • Myocardial infarction: acceleratedregimen (initiated within 6 hours) 15 mg
    \nIV bolus, 50 mg over 30 minutes, then
    \n35 mg over 1 hour (total dose 100 mg); or
    \n(if initiated within 6\u201312 hours) 10 mg over
    \n1\u20132 minutes followed by IV infusion of
    \n50 mg over 1 hour, then 4 infusions each
    \nof 10 mg over 30 minutes (total dose \u2013
    \n100 mg over 3 hours)<\/li>\n
  • Pulmonary embolism: 10 mg by IVinjection over 1\u20132 minutes, followed by an
    \ninfusion of 90 mg over 2 hours. Total dose
    \nshould not exceed 1.5 mg\/kg in patients
    \nwho weigh <65 kg<\/li>\n
  • Acute ischaemic stroke: 0.9 mg\/kg over\n

    60 minutes, 10% of dose as initial bolus;
    \nmaximum 90 mg. Start within 3 hours of
    \nsymptoms<\/p>\n

    PHARMACOKINETICS<\/h3>\n<\/li>\n
  • Molecular weight                           :
    \n65 000 (non-
    \nglycosylated protein)<\/li>\n
  • %Protein binding                           :
    \nNo data<\/li>\n
  • %Excreted unchanged in urine     :
    \nMinimal<\/li>\n
  • Volume of distribution (L\/kg)       :
    \n0.1<\/li>\n
  • half-life \u2013 normal\/ESRD (hrs)      :
    \n\u03b1: 4\u20135 minutes; \u03b2:
    \n40 minutes<\/p>\n

    DOSE IN RENAL IMPAIRMENT<\/h3>\n

    GFR (mL\/MIN)<\/h4>\n<\/li>\n
  • 20 to 50     : Dose as in normal renal function<\/li>\n
  • 10 to 20     : Dose as in normal renal function<\/li>\n
  • <10           :
    \nDose as in normal renal function<\/p>\n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES<\/h3>\n<\/li>\n
  • CAPD                :
    \nNot dialysed. Dose as in normal renal function<\/li>\n
  • HD                     :
    \nNot dialysed. Dose as in normal renal function<\/li>\n
  • HDF\/high flux   :
    \nUnknown dialysability. Dose as in
    \nnormal renal function<\/li>\n
  • CAV\/VVHD      :
    \nNot dialysed. Dose as in normal renal function<\/p>\n

    IMPORTANT DRUG INTERACTIONS<\/h3>\n

    Potentially hazardous interactions with other drugs<\/li>\n

  • Risk of haemorrhage can be increased bythe use of coumarin derivatives, platelet
    \naggregation inhibitors, heparin, and other
    \nagents influencing coagulation<\/p>\n

    ADMINISTRATION<\/h3>\n

    Reconstition<\/h4>\n<\/li>\n
  • 50 mg vial: dissolve in 50 mL water forinjection
    \n20 mg vial: dissolve in<\/li>\n
  • 20 mL water forinjection.
    \nThe reconstituted solutions can be further<\/p>\n

    diluted (minimum concentration 0.2 mg\/
    \nmL) with sterile sodium chloride 0.9%<\/p>\n

    Route<\/h4>\n

    IV<\/p>\n

    Rate of Administration<\/h4>\n

    See under dose<\/p>\n

    Comments<\/h4>\n<\/li>\n
  • Water or glucose solution must NOT beused for dilution<\/li>\n
  • 50 mg vial = 29 mega units\/vial<\/li>\n
  • 20 mg vial = 11.6 mega units\/vial
    \n

    OTHER INFORMATION<\/h4>\n<\/li>\n
  • Patients weighing less than 65 kg shouldreceive a total dose of 1.5 mg\/kg according
    \nto dose schedule<\/li>\n
  • Allergic reactions are less likely withalteplase than streptokinase and repeated
    \nadministration is possible<\/li>\n
  • 1.7 g arginine in the 50 mg vial, 0.7 garginine in 20 mg vial \u2013 may lead to
    \nhyperkalaemia in renal failure<\/li>\n
  • Pay attention to potential bleeding sitesduring treatment<\/li>\n
  • To unblock dialysis lines, use 2 mg in 2 mLdown each lumen and leave in situ for at
    \nleast 60 minutes or until the next dialysis
    \nsession<\/li>\n
  • Alternative regimens for unblockingdialysis lines: an infusion of 20 mg over
    \n20 hours, or 50 mg over 12 hours<\/li>\n","protected":false},"excerpt":{"rendered":"

    Alteplase CLINICAL USE Fibrinolytic drug: Acute myocardial infarction Pulmonary embolism<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-1623","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1623","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=1623"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1623\/revisions"}],"predecessor-version":[{"id":2940,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1623\/revisions\/2940"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=1623"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=1623"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=1623"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}