Formulary
Alteplase: Indications, Dosing, Side Effects and Interactions
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
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Alteplase: Indications, Dosing, Side Effects and Interactions
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
Drug action
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
Indications and dose
**Acute ischaemic stroke (under specialist neurology physician only)**
- **Adult** (By Intravenous Infusion): 900 micrograms/kg (max. per dose 90 mg), the initial 10% of dose is to be administered by intravenous injection and the remainder by intravenous infusion over 60 minutes, treatment should begin as soon as possible within 4.5 hours of symptom onset and when intracranial haemorrhage excluded by imaging. For further information on thrombolysis beyond 4.5 hours of symptom onset, see National Clinical Guideline for Stroke for the UK and Ireland .
**Thrombolytic treatment of occluded central venous access devices (including those used**
- **Adult** (By Intravenous Injection): for haemodialysis) (consult product literature).
**Intravascular thrombosis for alteplase**
- **Neonate** (By intravenous infusion): 100-500 micrograms/kg/hour for 3-6 hours, use ultrasound assessment to monitor effect before considering a second course of treatment (consult local protocol).
- **Child** (By intravenous infusion): 100-500 micrograms/kg/hour for 3-6 hours, use ultrasound assessment to monitor effect before considering a second course of treatment; maximum 100 mg per day.
**Thrombolytic treatment of occluded central venous access devices (including those used for haemodialysis) for Actilyse Cathflo**
- **Child** (By intravenous injection): (consult product literature).
Cautions
Conditions in which thrombolysis might give rise to embolic complications such as enlarged left atrium with atrial fibrillation (risk of dissolution of clot and subsequent embolisation); elderly; external chest compression; hypertension; risk of bleeding (including that from venepuncture or invasive procedures)
Contraindications
Acute pancreatitis; aneurysm; aortic dissection; arteriovenous malformation; bacterial endocarditis; bleeding diatheses; coagulation defects; coma; heavy vaginal bleeding; history of cerebrovascular disease (especially recent events or with any residual disability); neoplasm with risk of haemorrhage; oesophageal varices; pericarditis; recent gastro-intestinal ulceration; recent haemorrhage; recent surgery (including dental extraction); recent trauma; severe hypertension Contra-indications For alteplase General contra-indications: Recent delivery Specific contra-indications: When used for Acute ischaemic stroke Convulsion accompanying stroke; history of stroke in patients with diabetes; hyperglycaemia; hypoglycaemia; stroke in last 3 months
Side effects
Common or very common Anaphylactic reaction; angina pectoris; cardiac arrest; cardiogenic shock; chills; CNS haemorrhage; ecchymosis; fever; haemorrhage; heart failure; ischaemia recurrent (when used in myocardial infarction); nausea; pulmonary oedema; vomiting Uncommon Mitral valve incompetence; reperfusion arrhythmia (when used in myocardial infarction) Rare or very rare Seizure Side-effects, further information Serious bleeding calls for discontinuation of the thrombolytic and may require administration of coagulation factors and antifibrinolytic drugs. Side-effects For alteplase Common or very common Haemorrhagic stroke; hypotension Uncommon Haemothorax Rare or very rare Agitation; confusion; delirium; depression; epilepsy; psychosis; speech impairment Frequency not known Brain oedema (caused by reperfusion)
Interactions
**Other interactions (1):**
- Drugs affecting coagulation/platelet function The risk of haemorrhage is increased if coumarine derivatives, oral anticoagulants, platelet aggregation inhibitors, unfractionated heparin or LMWH or...
Pregnancy
Thrombolytic drugs can possibly lead to premature separation of the placenta in the first 18 weeks of pregnancy. There is also a risk of maternal haemorrhage throughout pregnancy and post-partum, and also a theoretical risk of fetal haemorrhage throughout pregnancy.
Hepatic impairment
Manufacturers advise avoid in severe impairment.
Medicinal forms
Solution,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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