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Alteplase - (ACTIVASE, TPA)
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document 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.

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:
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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).

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
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document 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.