Details About Generic Salt ::  Alteplas

Main Medicine Class:: Tissue plasminogen activator   

(AL-tuh-PLACE)
Activase,  Activast rt-PA
Class: Tissue plasminogen activator

 

Drugs Class ::

 Action Aids in dissolution of blood clots.

Indications for Drugs ::

 Indications Lysis of thrombi in management of acute MI or acute massive pulmonary embolism, management of acute ischemic stroke. Unlabeled use(s): Treatment of unstable angina pectoris.

Drug Dose ::

 Route/Dosage

Acute MI

Administer as soon as possible after the onset of symptoms. Do not use a dose of 150 mg because it has been associated with an increase in intracranial bleeding. Accelerated Infusion: The recommended dose is based upon patient weight £ 100 mg. For patients weighing > 67 kg, the recommended dose administered is 100 mg as a 15 mg IV bolus, followed by 50 mg infused over the next 30 min and then 35 mg infused over the next 60 min. For patients weighing £ 67 kg, the recommended dose is administered as a 15 mg IV bolus, followed by 0.75 mg/kg infused over the next 30 min not to exceed 50 mg and then 0.50 mg/kg over the next 60 min not to exceed 35 mg. (The safety and efficacy of this accelerated infusion of alteplase regimen has only been investigated with concomitant administration of heparin and aspirin). 3-Hour Infusion: 100 mg given as 60 mg (34.8 million IU) in the first hour (with 6 mg to 10 mg given as a bolus over the first 1 to 2 min), 20 mg (11.6 million IU) over the second hour and 20 mg (11.6 million IU) over the third hour. For smaller patients (< 65 kg), use a dose of 1.25 mg/kg given over 3 hours as described above. Concomitant Administration: Although the use of anticoagulants during and following alteplase has been shown to be of equivocal benefit, heparin has been given concomitantly for ³ 24 hours in > 90% of patients. Aspirin or dipyridamole has been given either during or following heparin treatment.

Acute Ischemic Stroke

ADULTS: IV The recommended dose is 0.9 mg/kg (max of 90 mg) infused over 60 min with 10% of the total dose administered as an initial IV bolus over 1 minute. The safety and efficacy of this regimen with concomitant administration of heparin and aspirin during the first 24 hr after symptom onset has not been investigated. Doses 0.9 mg/kg may be associated with an increased incidence of ICH. Do not use doses > 0.9 mg/kg (max 90 mg).

Pulmonary Embolism

ADULTS: IV 100 mg administered over 2 hr. Initiate or reinstate heparin therapy near the end of or immediately following the alteplase infusion when the partial thromboplastin time or TT returns to twice normal or less.

Contraindication ::

 Contraindications Active internal bleeding; history of cerebrovascular accident; intracranial hemorrhage; recent (within 2 mo) intracranial or intraspinal surgery or trauma; recent previous stroke; seizure at the onset of stroke; intracranial neoplasm; arteriovenous malformation or aneurysm; bleeding diathesis; severe uncontrolled hypertension.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Bleeding: Most frequent and serious adverse effect.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Hypotension. HEMA: Bleeding, both superficial (eg, venous cutdowns, arterial punctures, sites of surgical intervention) and internal (eg, GI tract, GU tract, pericardial, retroperitoneal or intracranial sites). OTHER: Mild hypersensitivity (eg, urticaria), fever.

Drug Mode of Action ::  

 Action Aids in dissolution of blood clots.

Drug Interactions ::

 Interactions

Aspirin, dipyridamole or heparin: May increase risk of bleeding. INCOMPATIBILITIES: Do not add other medications to infusion solution.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note cerebrovascular disease, hypertension, or recent internal bleeding.
  • Obtain drug history, noting use of aspirin, dipyridamole, or heparin because these drugs may increase risk of bleeding.
  • Ensure that coagulation studies have been performed before administration. These tests provide baseline values against which to monitor patient’s response to therapy.
  • Take pulse and BP before administration and monitor frequently during infusion.
  • Observe for internal or external bleeding before and during infusion.
  • Carefully monitor potential bleeding sites (eg, catheter insertion sites, arterial puncture sites) because fibrin will be lysed during therapy, resulting in new or increased bleeding.
  • Avoid IM injections and nonessential handling of patient during treatment.
  • Minimize number of arterial and venous punctures.
  • If arterial punctures are necessary, use site accessible to manual compression. Use manual pressure for ³ 30 min, apply pressure dressing and check site frequently for evidence of bleeding.
  • If serious bleeding occurs, stop infusion and any concomitant heparin and notify physician.
  • Observe for indications of hypersensitivity (eg, urticaria, fever). Nausea, vomiting, hypotension and fever are frequent sequelae of MI and may or may not be attributable to therapy.
  • If anaphylactic reaction occurs, stop infusion, notify physician and initiate appropriate therapy.

Drug Storage/Management ::

 Administration/Storage

  • Reconstitute immediately before use. Use large-bore (18-gauge) needle for reconstitution.
  • Do not use if vacuum has been broken.
  • Reconstitute only with accompanying Sterile Water for Injection. Do not use Bacteriostatic Water for Injection.
  • Administer by IV infusion only.
  • Do not administer if solution is discolored or if sediment is present.
  • Store lyophilized alteplase at room temperature or refrigerate. May be used for IV administration within 8 hr when stored at room temperature.
  • Initiate treatment for stroke only within 3 hrs after the onset of symptoms.

Drug Notes ::

 Patient/Family Education

  • Explain drug action and need for frequent monitoring, including blood tests and vital signs.
  • Instruct patient to report any new bleeding sites or increased bleeding, dizziness, headache, numbness, or tingling.
  • Tell patient to report urticaria or fever.
  • Instruct patient to avoid getting out of bed without assistance during treatment.

Disclaimer ::

The Information available on this site is for only Informational Purpose , before any use of this information please consult your Doctor .Price of the drugs indicated above may not match to real price due to many possible reasons may , including local taxes etc.. These are only approximate indicative prices of the drug.

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