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Intravenous Dilution Guidelines

Alteplase - (ACTIVASE, TPA)

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer

Usual Diluents

NS, D5W

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

Note: Sterile water without preservative
[50 mg vial] [50 ml - SW] [UD]
[100 mg vial] [100 ml - SW ] [UD]

Peripheral arterial occlusive disease: Continuous infusion of alteplase: 0.5 to 2 mg/hr x 6 to 72 hours depending on location. Preparation: Dilute alteplase with sterile water as above, then further dilute with NS to produce one of the following concentrations below:

Concentration (0.1 mg/ml)
[25 mg] [250ml]
[50 mg] [500 ml]

Concentration (0.2 mg/ml)
[50 mg] [250ml]

Alternatives:
-------------------------------------------
Concentration (0.025 mg/ml)
[12.5 mg] [500ml]

Concentration (0.05 mg/ml)
[25 mg] [500ml]

Stability / Miscellaneous

EXP: 8 hours (RT). Prepare just before use. Results in concentration of 1 mg/ml. May be infused at this concentration or may dilute further with equal volume of normal saline or D5W (0.5 mg/ml).

Stability data:

Drug Stability
Refrigerated
Stability
Room Temp.
Reconstituted
Vial/Powder
Notes P-Insert
Updated
Alteplase Kit Store lyophilized Activase under refrigeration not to exceed (2-8°C/36-46°F). Protect the lyophilized material during extended storage from excessive exposure to light. If stored between 2-30°C (36-86°F), Activase may be used within 8 hours following reconstitution.
Store lyophilized Activase at controlled room temperature not to exceed 30°C (86°F). Protect the lyophilized material during extended storage from excessive exposure to light. If stored between 2-30°C (36-86°F), Activase may be used within 8 hours following reconstitution.
Kit Discard any unused solution after administration is complete.

Do not use beyond the expiration date stamped on the vial.
02 24 15
Alteplase (TPA) Store lyophilized Cathflo Activase at refrigerated temperature (2–8°C/36–46°F).

The solution may be used for intracatheter instillation within 8 hours following reconstitution when stored at 2–30°C (36–86°F).
The solution may be used for intracatheter instillation within 8 hours following reconstitution when stored at 2–30°C (36–86°F). Powder Any unused solution should be discarded.

Do not use beyond the expiration date on the vial. Protect the lyophilized material during extended storage from excessive exposure to light.
10 08 13


Dosing:
Acute MI
: (2 protocols)-
(1) (Preferred) Accelerated infusion: for patients > 65kg: 15 mg IV bolus f/b 50mg over next 30min, and the remaining 35mg (100mg total) infused over the next 60 min. Patients <65kg: 15 mg bolus, then 0.75 mg/kg (max 50 mg) over 30 minutes, then 0.5 mg/kg (max 35 mg) over next 60 minutes.

(2) 3-hour infusion (may be less effective): In 1st hour, 60 mg is administered (of which 6-10mg is administered ivpush in first 1-2 minutes), followed by 20 mg/hr x 2 hours. (100mg total). For patients <65 kg: administer 1.25 mg/kg in the same manner over 3 hours.

Pulmonary embolism: 100 mg over 2 hours.
Stroke: (Give within first 3 hours): 0.9 mg/kg (max 90mg)-10% of dose given ivpush, followed by a continuous infusion over 1 hour.

Intracatheter: Central venous catheter clearance: Cathflo™ Activase®:

Patients >/= 10 to <30 kg: 110% of the internal lumen volume of the catheter ( </=2 mg [1 mg/mL]); retain in catheter for </=2 hours; may instill a second dose if catheter remains occluded

Patients >/= 30 kg: 2 mg (1 mg/mL); retain in catheter for </=2 hours; may instill a second dose if catheter remains occluded

Intra-arterial: Acute peripheral arterial occlusive disease (unlabeled use): 0.02-0.1 mg/kg/hour for up to 36 hours

Advisory Panel to the Society for Cardiovascular and Interventional Radiology on Thrombolytic Therapy recommendation: </=2 mg/hour and subtherapeutic heparin (aPTT <1.5 times baseline)

Additional info
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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