Alteplase
ACTIVASE
Pronunciation: AL-te-plays
What it isRecombinant tissue plasminogen activator converting plasminogen to plasmin; acute ischemic stroke, STEMI and massive PE.
Why this oneIt dissolves clot that has already formed, which no anticoagulant does.
What limits it⚑ Benefit falls steeply after 4.5 hours in stroke. Intracranial hemorrhage is the price; screen every contraindication before use.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute ischemic stroke | Adults | 0.9 mg/kg IV (max 90 mg): 10% as bolus over 1 min, remainder over 60 min | 90 mg total | |
| Acute myocardial infarction | Adults | Weight-based (accelerated or 3-h regimen) | 100 mg total | |
| Acute massive pulmonary embolism | Adults | 100 mg IV over 2 h | 100 mg |
Renal Undefined
Hepatic Undefined
Instructions
- Give AIS within 3 hours of symptom onset; frequently monitor/control blood pressure
- Do not add other medications to Activase infusions
Available strengths
- inj 50, 100 mg/vial
Contraindications
- Active internal bleeding
- Recent (within 3 months) intracranial/intraspinal surgery or serious head trauma
- Intracranial conditions that may increase bleeding risk (neoplasm, AVM, aneurysm)
- Bleeding diathesis
- Current severe uncontrolled hypertension
- AIS: current intracranial hemorrhage or subarachnoid hemorrhage
- AMI/PE: history of recent stroke
Cautions
- Bleeding (incl. intracranial hemorrhage)
- Hypersensitivity/angioedema
- Thromboembolism
- Cholesterol embolization
Adverse reactions
- Bleeding (most frequent, incl. intracranial hemorrhage)
Pregnancy Undefined
Lactation Undefined
Cost
Alteplase (ACTIVASE)
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 50 mg/vial | inj | per unit | not offered | |
| 100 mg/vial | inj | per unit | not offered |
NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Alteplase is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.
NO BOXED WARNINGS
Principal riskIntracranial hemorrhage; the time window is everything