Dosing & Uses
Dosage Forms & Strengths
powder for injection
- 10.4 units (18.1mg)
Acute Myocardial Infarction
10 units IV bolus (over 2 minutes), THEN
Second dose given 30 minutes after first (for total cumulative dose of 20 units)
Treatment should be initiated ASAP after onset of AMI
Give each bolus injection via an IV line in which no other medication is being simultaneously injected or infused
Safety & efficacy not established
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Reperfusion arrhythmias, hypotension
Dizziness, fever, severe headache
Anemia, cholesterol embolization, GI/GU bleeding, intracranial hemorrhage
Allergic reaction, injection site reaction
Active bleeding, recent CVA, recent intracranial or intraspinal surgery or trauma, intracranial neoplasm, AVM, aneurysm, bleeding diathesis, severe uncontrolled HTN
See thrombolytic indications/contraindications
Recent major surgery, cerebrovascular disease, recent GI or GU bleeding, HTN, acute pericarditis, hemostatic defects, severe thrombophlebitis, severe hepatic/renal dysfunction, currently receiving oral anticoagulants, diabetic hemorrhagic retinopathy, elderly
Monitor potential bleeding sites
Cholesterol embolism reported
Ischemic Stroke: may have no benefit if used after 3 hr of onset
Current use of warfarin and INR in high range may increase bleeding risk
Pregnancy & Lactation
Pregnancy Category: C
Lactation: Not known whether drug crosses into breast milk, unlikely patients will be concerned about nursing in indicated circumstances
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Reteplase is the r-PA (recombinant plasminogen activator) with nonglycosylated deletion mutant of wild-type tissue plasminogen activator (tPA); has less high-affinity fibrin binding, longer half-life, & greater thrombolytic potency than tPA
Promotes thrombolysis by converting plasminogen to plasmin which degrades fibrin & fibrinogen
Half-Life: 13-16 min
Onset: Coronary thrombolysis occurs in 30 min, reaches peak response at 30-90 min
Metabolism: Inactivated by blood components C1 inactivator, alfa-1-antitrypsin, alfa-2-antiplasmin
Excretion: Urine and feces
Plasma clearance: 250-450 mL/min
Additive, Syringe, Y-site: heparin
Reconstitute using diluent, needle, syringe & dispensing pin provided to obtain 1 U/mL soln
Bolus over 2 min
Do not admin solutions that are discolored or contain precipitate
Slight foaming may occur
- May need to stand undisturbed for several minutes to dissipate bubbles
Flush before & after each bolus
Line to contain D5W
Stable for 4 hr at room temp
Adding plans allows you to compare formulary status to other drugs in the same class.
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Adding plans allows you to:
- View the formulary and any restrictions for each plan.
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.