BMA Concise Guide to Medicine & Drugs

Alteplase

Brand name Actilyse

Used in the following combined preparations None

QUICK REFERENCE

Drug group Thrombolytic drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Alteplase belongs to a group of drugs called thrombolytics, which act by dissolving blood clots that have formed in blood vessels. Synthesized by genetically modified bacteria, alteplase works by dissolving the fibrin in blood clots. It is used to treat a number of conditions caused by clots in blood vessels, including heart attacks due to clots in the arteries of the heart, pulmonary embolism due to clots in the lungs’ blood vessels, and acute stroke caused by a clot in an artery of the brain.

Alteplase is administered via a catheter inserted into a vein and works rapidly. It is given within a few hours of a heart attack or stroke to reduce the amount of damage to the heart or brain. As with other thrombolytic agents, alteplase is associated with a risk of bleeding, which may occasionally be life-threatening, so treatment is closely supervised.

INFORMATION FOR USERS

This drug is given only under medical supervision and is not for self-administration.

How taken/used Injection, infusion.

Frequency and timing of doses Usually given as a single intravenous injection followed by a continuous intravenous infusion over several hours.

Adult dosage range Dosage is determined individually based on the condition being treated and the patient’s body weight.

Onset of effect 30 minutes.

Duration of action 60 minutes.

Diet advice None.

Storage Not applicable. The drug is not normally kept at home.

Missed dose Not applicable. The drug is given only in hospital under close supervision.

Stopping the drug The drug is usually given over several hours and then stopped.

Exceeding the dose Overdose is unlikely as treatment is closely monitored by medical staff.

POSSIBLE ADVERSE EFFECTS

Alteplase is given under strict medical supervision and adverse effects are closely monitored. The main adverse effect is bleeding, which is common where the catheter is inserted but may occur anywhere in the body. Nausea and vomiting are also common. Other adverse effects include collapse, rash, wheezing, and swelling of the lips and/or face. Any adverse effects should be reported to medical staff immediately.

INTERACTIONS

Anticoagulant drugs (e.g. warfarin, heparin) There is an increased risk of bleeding when these are taken before, during, or soon after alteplase is used.

Antiplatelet drugs (e.g. aspirin, clopidogrel) There is an increased risk of bleeding when these are taken before, during, or soon after alteplase is used.

SPECIAL PRECAUTIONS

Alteplase is only prescribed under close medical supervision, usually in life-threatening circumstances. Your doctor will usually go through a checklist of questions before administering the drug to assess your risk of bleeding.

Pregnancy Safety not established. Alteplase carries a risk of bleeding for the mother and baby and may damage the placenta. Discuss with your doctor.

Breast-feeding Safety not established. Breast milk should not be used for 24 hours after treatment with alteplase. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Increased risk of bleeding. Close observation required.

Driving and hazardous work Not applicable.

Alcohol Not applicable.

PROLONGED USE

Alteplase is never used long term.