page178
Dose
. Myocardial infarction,
accelerated regimen (initiated
within 6 hours of symptom onset),
15 mg
by intra-
venous injection, followed by intravenous infusion of
50 mg over 30 minutes,
then 35 mg over 60 minutes
(total dose 100 mg over 90 minutes);
in patients less
than 65 kg,
15 mg
by intravenous injection,
followed
by intravenous infusion of 0.75 mg/kg over 30 min-
utes, then 0.5 mg/kg over 60 minutes (max. total dose
100 mg over 90 minutes)
. Myocardial infarction,
initiated within 6–12 hours of
symptom onset,
10 mg by intravenous injection,
fol-
lowed by intravenous infusion of 50 mg over 60
minutes,
then 4 infusions each of 10 mg over 30
minutes (total dose 100 mg over 3 hours;
max.
1.5 mg/kg in patients less than 65 kg)
. Pulmonary embolism, 10 mg by intravenous injection
over 1–2 minutes, followed by intravenous infusion of
90 mg over 2 hours;
max.
1.5 mg/kg in patients less
than 65 kg
. Acute stroke (treatment must begin within 3 hours of
symptom onset), by intravenous administration over
60 minutes,
900 micrograms/kg (max.
90 mg);
initial
10% of dose by intravenous injection,
remainder by
intravenous infusion;
ELDERLY
over 80 years not
recommended
Actilyse
c
(Boehringer Ingelheim) A
Injection
,
powder for reconstitution,
alteplase 10 mg
(5.8 million units)/vial, net price per vial (with diluent)
= £120.00; 20 mg (11.6 million units)/vial (with diluent
and transfer device) = £180.00;
50 mg (29 million -
units)/vial (with diluent, transfer device, and infusion
bag) = £300.00
RETEPLASE
Indications
acute myocardial infarction (see notes
above and section 2.10.1)
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Pregnancy
see notes above
Breast-feeding
manufacturer advises avoid breast-
feeding for 24 hours after dose (express and discard
milk during this time)
Side-effects
see notes above
Dose
. By intravenous injection (initiated within 12 hours of
symptom onset), 10 units over not more than 2 min-
utes,
followed after 30 minutes by a further 10 units
Rapilysin
c
(Actavis) A
Injection
,
powder for reconstitution,
reteplase
10 units/vial, net price pack of 2 vials (with 2 prefilled
syringes of diluent and transfer device) = £627.97
STREPTOKINASE
Indications
acute myocardial infarction (see notes
above and section 2.10.1);
deep-vein thrombosis,
pulmonary embolism,
acute arterial thromboembo-
lism, and central retinal venous or arterial thrombosis
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Pregnancy
see notes above
Side-effects
see notes above
Dose
. Myocardial infarction (initiated within 12 hours of
symptom onset),
by intravenous infusion,
1.5 million
units over 60 minutes
. Deep-vein thrombosis,
pulmonary embolism,
acute
arterial thromboembolism,
central retinal venous or
arterial thrombosis,
by intravenous infusion,
250 000 units over 30 minutes,
then 100 000 units
every hour for up to 12–72 hours according to con-
dition with monitoring of clotting parameters (consult
product literature)
Streptase
c
(CSL Behring) A
Injection
,
powder for reconstitution,
streptokinase,
net price 250 000-unit vial = £15.91; 750 000-unit vial
= £41.72;
1.5 million-unit vial = £83.44 (hosp.
only)
TENECTEPLASE
Indications
acute myocardial infarction (see notes
above and section 2.10.1)
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Pregnancy
see notes above
Breast-feeding
manufacturer advises avoid breast-
feeding for 24 hours after dose (express and discard
milk during this time)
Side-effects
see notes above
Dose
. By intravenous injection over 10 seconds (initiated
within 6 hours of symptom onset), 30–50 mg accord-
ing to body-weight—consult product literature;
max.
50 mg
Metalyse
c
(Boehringer Ingelheim) A
Injection
, powder for reconstitution, tenecteplase, net
price 40-mg (8000-unit) vial = £502.25;
50-mg
(10 000-unit) vial = £502.25 (both with prefilled
syringe of water for injection)
UROKINASE
Indications
thromboembolic occlusive vascular dis-
ease including deep-vein thrombosis,
pulmonary
embolism,
and peripheral vascular occlusion;
occluded intravenous catheters and cannulas blocked
by fibrin clots
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Pregnancy
see notes above
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
see notes above
Dose
. Deep-vein thrombosis,
by intravenous infusion,
initi-
ally 4400 units/kg in 15 mL sodium chloride 0.9%
over 10 minutes,
followed by 4400 units/kg/hour for
12–24 hours
. Pulmonary embolism,
by intravenous infusion,
initi-
ally 4400 units/kg in 15 mL sodium chloride 0.9%
over 10 minutes,
followed by 4400 units/kg/hour for
12 hours
or
by injection into pulmonary artery, initially
15 000 units/kg, subsequent doses adjusted according
to response;
max.
3 doses in 24 hours
158
2.10.2 Fibrinolytic drugs
BNF 61
2
Cardiovascular system