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SENSORY ORGANS › OPHTHALMOLOGICALS › OTHER OPHTHALMOLOGICALS › Other ophthalmologicals
alteplase
S01XA13
Forms & Strengths
- Lyophilized powder for injection: 50 mg (29 million IU) per vial
- Lyophilized powder for injection: 100 mg (58 million IU) per vial
Adult Dosing
- Acute ischemic stroke: 0.9 mg/kg (maximum 90 mg) IV; 10% as initial bolus over 1 minute, remainder infused over 60 minutes within 3.5 to 4 hours of symptom onset
- Acute massive pulmonary embolism: 100 mg IV infusion over 2 hours
- Acute myocardial infarction (accelerated infusion): 15 mg IV bolus, then 0.75 mg/kg (up to 50 mg) over 30 minutes, then 0.5 mg/kg (up to 35 mg) over 60 minutes
- Central venous catheter clearance: 2 mg in 2 mL instilled into occluded catheter lumen
Pediatric Dosing
- Safety and efficacy not established in pediatric stroke or myocardial infarction
- Catheter occlusion (children >= 30 kg): 2 mg in 2 mL instilled into lumen
- Catheter occlusion (children < 30 kg): 1.1 times the internal lumen volume of the catheter (not to exceed 2 mg in 1 mL or 2 mL)
Indications
- Management of acute ischemic stroke to improve neurological recovery
- Management of acute massive pulmonary embolism
- Management of acute myocardial infarction for lysis of coronary thrombi
- Restoration of function to occluded central venous access devices
Mechanism of Action
- Recombinant tissue-type plasminogen activator (rt-PA)
- Binds to fibrin in a thrombus and converts entrapped plasminogen to plasmin
- Initiates local fibrinolysis, leading to dissolution of blood clots
Contraindications
- Active internal bleeding
- History of cerebrovascular accident, intracranial hemorrhage, or subarachnoid hemorrhage
- Intracranial or intraspinal surgery or severe head trauma within recent months
- Intracranial neoplasm, arteriovenous malformation, or aneurysm
- Severe uncontrolled hypertension
- Known bleeding diathesis
Adverse Reactions
- Major and minor bleeding events, including intracranial hemorrhage
- Orolingual angioedema
- Hypotension
- Reperfusion arrhythmias (during myocardial infarction treatment)
- Allergic reactions including anaphylaxis
Drug Interactions
- Anticoagulants (e.g., heparin, warfarin, direct oral anticoagulants) increase the risk of hemorrhage
- Antiplatelet agents (e.g., aspirin, P2Y12 inhibitors) increase bleeding risk
- ACE inhibitors may increase the risk of angioedema when coadministered with alteplase in acute ischemic stroke
Curated Content: Needs Vetting Before Put to Clinical Use