{"id":3675,"date":"2025-03-31T18:11:47","date_gmt":"2025-03-31T18:11:47","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/alteplase-txt\/"},"modified":"2025-03-31T18:11:47","modified_gmt":"2025-03-31T18:11:47","slug":"alteplase-txt","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/alteplase-txt\/","title":{"rendered":"Alteplase.txt"},"content":{"rendered":"

Alteplase<\/h1>\n

CLINICAL USE <\/H3>
\nFibrinolytic drug:<\/p>\n
  • Acute myocardial infarction\n
  • Pulmonary embolism\n
  • Acute ischaemic stroke\n
  • To unblock dialysis lines (unlicensed\n

    indication)
    \n

    DOSE IN NORMAL RENAL FUNCTION <\/H3><\/p>\n
  • Myocardial infarction: accelerated\n

    regimen (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)<\/p>\n

  • Pulmonary embolism: 10 mg by IV\n

    injection 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<\/p>\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
    \n

    PHARMACOKINETICS <\/H3>
    \n
  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
    \n65 000 (non-
    \nglycosylated protein)\n<\/li>\n
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
    \nNo data\n<\/li>\n
  • %Excreted unchanged in urine &nbsp &nbsp :
    \nMinimal\n<\/li>\n

  • Volume of distribution (L\/kg) &nbsp &nbsp &nbsp :
    \n0.1\n<\/li>\n

  • half-life \u2013 normal\/ESRD (hrs)&nbsp &nbsp &nbsp :
    \n\u03b1: 4\u20135 minutes; \u03b2:
    \n40 minutes
    \n

    DOSE IN RENAL IMPAIRMENT <\/H3>
    \n

    GFR (mL\/MIN)<\/H4>
    \n
  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
    \n
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
    \n
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp :
    \nDose as in normal renal function
    \n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES <\/H3>
    \n
  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:
    \nNot dialysed. Dose as in normal renal function<\/p>\n
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :
    \nNot dialysed. Dose as in normal renal function
    \n
  • HDF\/high flux &nbsp :
    \nUnknown dialysability. Dose as in
    \nnormal renal function
    \n
  • CAV\/VVHD &nbsp &nbsp &nbsp:
    \nNot dialysed. Dose as in normal renal function
    \n

    IMPORTANT DRUG INTERACTIONS <\/H3>
    \nPotentially hazardous interactions with other drugs<\/p>\n
  • Risk of haemorrhage can be increased by\n

    the use of coumarin derivatives, platelet
    \naggregation inhibitors, heparin, and other
    \nagents influencing coagulation
    \n

    ADMINISTRATION <\/H3>
    \n

    Reconstition<\/H4><\/p>\n
  • 50 mg vial: dissolve in 50 mL water for\n

    injection
    \n20 mg vial: dissolve in <\/p>\n

  • 20 mL water for\n

    injection.
    \nThe reconstituted solutions can be further <\/p>\n

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

    Route <\/H4>
    \nIV<\/p>\n

    Rate of Administration <\/H4>
    \nSee under dose<\/p>\n

    Comments<\/H4><\/p>\n
  • Water or glucose solution must NOT be\n

    used for dilution<\/p>\n

  • 50 mg vial = 29 mega units\/vial\n
  • 20 mg vial = 11.6 mega units\/vial\n

    OTHER INFORMATION <\/H4><\/p>\n
  • Patients weighing less than 65 kg should\n

    receive a total dose of 1.5 mg\/kg according
    \nto dose schedule<\/p>\n

  • Allergic reactions are less likely with\n

    alteplase than streptokinase and repeated
    \nadministration is possible<\/p>\n

  • 1.7 g arginine in the 50 mg vial, 0.7 g\n

    arginine in 20 mg vial \u2013 may lead to
    \nhyperkalaemia in renal failure<\/p>\n

  • Pay attention to potential bleeding sites\n

    during treatment<\/p>\n

  • To unblock dialysis lines, use 2 mg in 2 mL\n

    down each lumen and leave in situ for at
    \nleast 60 minutes or until the next dialysis
    \nsession<\/p>\n

  • Alternative regimens for unblocking\n

    dialysis lines: an infusion of 20 mg over
    \n20 hours, or 50 mg over 12 hours<\/p>\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":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-3675","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\/3675","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=3675"}],"version-history":[{"count":0,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/3675\/revisions"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=3675"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=3675"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=3675"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}