৳ 48,000/unit
Pack: ৳ 48,000
৳ 48,000/unit
Pack: ৳ 48,000
At a glance
Alteplase is a thrombolytic medication that dissolves harmful blood clots in blood vessels. It is used for the treatment of stroke, heart attack and pulmonary embolism.
Indications
Acute ischemic stroke (within 3-4.5 hours of symptom onset), acute myocardial infarction (heart attack), pulmonary embolism, central venous catheter occlusion.
Pharmacology
Alteplase is a serine protease responsible for fibrin-enhanced conversion of plasminogen to plasmin. It produces limited conversion of plasminogen in the absence of fibrin. When introduced into the systemic circulation at pharmacologic concentration, alteplase binds to fibrin in a thrombus and converts the entrapped plasminogen to plasmin. This initiates local fibrinolysis with limited systemic proteolysis.
Dosage
Acute Ischemic Stroke:
- 0.9 mg/kg IV (max 90 mg total dose)
- 10% of total dose as IV bolus over 1 minute, remainder infused over 60 minutes
- Initiate within 3-4.5 hours of symptom onset
- Discontinue if INR >1.7 or aPTT is elevated
Acute Myocardial Infarction (Heart Attack):
- Weight-based dose (max 100 mg)
- Accelerated regimen (1.5 hr): 15 mg IV bolus (1-2 min), then 50 mg over 30 min, remaining 35 mg over 60 min
- 3-hour regimen: 6-10 mg IV bolus, then 50-54 mg in 1st hour, then 20 mg/hour for next 2 hours
Pulmonary Embolism:
- 100 mg IV infusion over 2 hours
Central Venous Catheter Occlusion:
- 2 mg (2 mL) instilled into occluded catheter
- Attempt to aspirate after 30 minutes; 2nd dose may be given after 120 minutes
Side effects
Most common and serious side effect: Bleeding (hemorrhage) - internal bleeding, cerebral hemorrhage, injection site bleeding, nosebleeds, gum bleeding, black or tarry stools.
Other side effects: Decreased blood pressure, nausea, vomiting, fever, allergic reactions, orolingual angioedema (swelling of tongue and throat), cholesterol embolization, reembolization.
Use in pregnancy
Pregnancy Category: C. Animal studies have shown harmful effects on the fetus (embryocidal in rabbits at 3 mg/kg). Use only if clearly needed with medical advice.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Precautions & warnings
- Bleeding risk: Most serious side effect. Avoid intramuscular injections. Monitor for bleeding. Discontinue alteplase if serious bleeding occurs.
- Angioedema: Monitor during and for several hours after infusion. Discontinue if angioedema develops.
- Cholesterol embolization: Rarely reported with thrombolytic agents.
- Reembolization: Consider risk of reembolization from lysis of underlying DVT in PE patients.
- Pregnancy: Animal studies have shown harmful effects on the fetus; use only if clearly needed.
Overdose effects
Overdose symptoms: bleeding (hemorrhage). Treatment: discontinue alteplase, control bleeding, blood transfusion if needed.
Storage conditions
Store lyophilized alteplase below 30°C or at 2-8°C. Use within 8 hours of reconstitution.