Alteplase instructions for administration

Dosage and Administration
Acute Ischemic Stroke Acute Myocardial Infarction Pulmonary Embolism Restoration of Function to Central Venous Catheter General Advice --

Adults
IV The recommended dose is 0.9 mg/kg (max, 90 mg) infused over 60 min with 10% of the total dose administered as an initial IV bolus over 1 min. The safety and efficacy of this regimen with coadministration of heparin and aspirin during the first 24 h 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 more than 0.9 mg/kg (max. 90 mg).

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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.

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Accelerated infusion
The recommended dose is based upon patient weight; do not exceed 100 mg. For patients weighing more than 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 or less, 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 0.5 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 coadministration of heparin and aspirin). 3-h infusion

100 mg given as 60 mg (34.8 million units) in the first hour (with 6  to 10 mg given as a bolus over the first 1 to 2 min), 20 mg (11.6 million units) over the second hour and 20 mg (11.6 million units) over the third hour. For smaller patients (less than 65 kg), use a dose of 1.25 mg/kg given over 3 h as described above.

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Coadministration
Although the use of anticoagulants during and following alteplase has been shown to be of equivocal benefit, heparin has been given concomitantly for at least 24 h in more than 90% of patients. Aspirin or dipyridamole has been given during or following heparin treatment.

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

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Adults
IV Instill into dysfunctional catheter at a concentration of 1 mg/mL. For patients weighing 30 kg or more, use 2 mg/2 mL; for patients weighing 10 kg or more to less than 30 kg, use 110% of the internal lumen volume of the catheter (max, 2 mg/2 mL). If catheter function is not restored in 120 min after 1 dose, a second dose may be instilled.

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General Advice

 * Reconstitute lyophilized powder following manufacturer's recommendations using sterile water for injection. Do not reconstitute with bacteriostatic water for injection.
 * Reconstituted solution may be further diluted immediately before injection for treatment of acute MI or pulmonary embolus with an equal volume of sodium chloride 0.9% injection or dextrose 5% injection.
 * Mix by gentle swirling or gentle inversion. Avoid excessive agitation during reconstitution.
 * Use reconstituted solution immediately or within 8 h if stored properly.
 * Do not add any other medications to infusion solution.
 * Do not administer if particulate matter or discoloration noted. A pale yellow color is normal and is of no concern.
 * Discard any unused solution.
 * Initiate treatment for stroke only within 3 h after onset of symptoms and after exclusion of intracranial hemorrhage.

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