Alteplase

Alteplase is a prescription medication used to break up or dissolve blood clots.

Alteplase belongs to a group of drugs called thrombolytics. These dissolve blood clots quickly to help restart blood flow to the heart and helps prevent damage to the heart muscle.

This medication is available in an injectable form to be given directly into a vein by a healthcare professional.

A common side effect of alteplase is bleeding.

Alteplase is a prescription medication used to treat:

• Acute myocardial infarction (heart attack)
• Acute ischemic stroke (loss of blood flow to the brain)
• Pulmonary embolism (blood clot that has traveled to the lungs)

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Alteplase may be found in some form under the following brand names:

• Actilyse

• Actilyse Cathflo

• Activase

• Cathflo Activase

Serious side effects have been reported with alteplase. See the “Alteplase Precautions” section.

Common side effects of alteplase include bleeding. 

This is not a complete list of alteplase's side effects. Ask your doctor or pharmacist for more information. Tell your doctor if you have any side effect that bothers you or does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• anticoagulant (blood thinner) medications such as warfarin (Coumadin, Jantoven), heparin, enoxaparin (Lovenox), fondaparinux (Arixtra), rivaroxaban (Xarelto), and apixaban (Eliquis)
• aspirin

This is not a complete list of alteplase drug interactions. Ask your doctor or pharmacist for more information

Serious side effects have been reported with alteplase including the following:

• Bleeding. Tell your healthcare provider right away if you have some or all of the following symptoms of bleeding.
  • bruising
  • bloody or black, tarry stools
  • bloody vomit
  • vomiting blood or brown material that resembles coffee grounds

Do not take alteplase if you:

• are allergic to alteplase or any of its ingredients
• have an active bleed
• have a history of a brain injury
• have had recent major surgery or trauma especially in the head
• serevely uncontrolled high blood pressure
• have or have had any problems managing bleeding conditions in the past

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of alteplase, there are no specific foods that you must exclude from your diet when recieving this medication.

Before taking alteplase, tell your doctor about all of your medical conditions. Especially tell your doctor is you:

• are allergic to alteplase or any of its ingredients
• are over 75 years old
• are pregnant or breastfeeding
• are taking oral anticoagulants (blood thinners), see the “Alteplase Drug Interactions” section.
• have had recent major surgery or trauma
• have had a previous stroke or heart attack
• have had black, tarry stools or blood in the urine recently
• have hypertension (high blood pressure): systolic BP ≥175 mm Hg and/or diastolic BP ≥110 mm Hg
• have had a recent infection
• have heart problems
• have eye problems 
• have kidney problems
• have liver problems
• have or have had any problems managing bleeding conditions in the past

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Alteplase falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if alteplase crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using alteplase.

Take alteplase exactly as prescribed.

This medication is available in an injectable form to be given directly into a vein (IV) by a healthcare professional.

The dose your doctor recommends may be be based on your weight.

The recommended dose/dose range of alteplase for the treatment of myocardial infarction (heart attack) for patients weighing more than 67kg is 100mg and given in the following manner:

• Accelerated infusion
  • 15mg bolus (one-time) dose
  • 50mg dose infused (given over) next 30 minutes
  • 35mg dose infused (given over) next 60 minutes
• 3 hour infusion
  • 60mg (of which 6-10 mg given as a one-time dose) infused (given over) in the first hour
  • 20mg infused (given over) over the second hour
  • 20mg infused (given over) over the third hour

The recommended dose/dose range of alteplase for the treatment of stroke is 0.9 mg/kg (not to exceed 90mg total dose) and is given in the following manner:

• 10% of the total dose given as a bolus (one-time dose) over 1 minute
• the remaining 90% is infused (given over) over 60 minutes

The recommended dose/dose range of alteplase for the treatment of pulmonary embolism (blood clot in lung) is 100mg infused (given over) over 2 hours. 

If alteplase is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

Alteplase should be stored at room temperature not to exceed 30°C (86°F), or refrigerated (2°–8°C/36°–46°F). Protect alteplase from excessive exposure to light.