reteplase (Rx)

Brand and Other Names:Retavase
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 10.4 units (18.1mg)
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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

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Interactions

Interaction Checker

and reteplase

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Reperfusion arrhythmias, hypotension

            Dizziness, fever, severe headache

            Anemia, cholesterol embolization, GI/GU bleeding, intracranial hemorrhage

            Nausea, vomiting

            Cardiac reinfarction

            Cardiogenic shock

            Muscle pain

            Allergic reaction, injection site reaction

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            Warnings

            Contraindications

            Hypersensitivity

            Active bleeding, recent CVA, recent intracranial or intraspinal surgery or trauma, intracranial neoplasm, AVM, aneurysm, bleeding diathesis, severe uncontrolled HTN

            See thrombolytic indications/contraindications

            Cautions

            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

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Not known whether drug crosses into breast milk, unlikely patients will be concerned about nursing in indicated circumstances

            Pregnancy Categories

            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.

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            Pharmacology

            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

            Pharmacokinetics

            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

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            Administration

            IV Incompatibilities

            Y-site: bivalirudin

            Additive, Syringe, Y-site: heparin

            IV Preparation

            Reconstitute using diluent, needle, syringe & dispensing pin provided to obtain 1 U/mL soln

            IV Administration

            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

            Stability

            Stable for 4 hr at room temp

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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.

            Tier Description
            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.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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