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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (2)
- defibrotide
defibrotide increases effects of reteplase by pharmacodynamic synergism. Contraindicated. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. This does not include use for routine maintenance or reopening of central venous lines.
- prothrombin complex concentrate, human
reteplase, prothrombin complex concentrate, human. pharmacodynamic antagonism. Contraindicated.
Serious - Use Alternative (4)
- apixaban
reteplase and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.
- caplacizumab
caplacizumab, reteplase. Either increases effects of the other by anticoagulation. Avoid or Use Alternate Drug.
- tenecteplase
reteplase and tenecteplase both increase anticoagulation. Avoid or Use Alternate Drug.
- zanubrutinib
reteplase, zanubrutinib. Either increases effects of the other by anticoagulation. Avoid or Use Alternate Drug. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.
Monitor Closely (76)
- agrimony
reteplase and agrimony both increase anticoagulation. Modify Therapy/Monitor Closely.
- alfalfa
reteplase and alfalfa both increase anticoagulation. Modify Therapy/Monitor Closely.
- alteplase
alteplase and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- American ginseng
reteplase and American ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.
- anamu
reteplase and anamu both increase anticoagulation. Use Caution/Monitor.
- antithrombin alfa
antithrombin alfa and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- antithrombin III
antithrombin III and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- argatroban
argatroban and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- aspirin
aspirin, reteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
- aspirin rectal
aspirin rectal and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate, reteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
- azficel-T
azficel-T, reteplase. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.
- bivalirudin
bivalirudin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- celecoxib
celecoxib and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- choline magnesium trisalicylate
choline magnesium trisalicylate and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- cinnamon
reteplase and cinnamon both increase anticoagulation. Modify Therapy/Monitor Closely.
- cordyceps
reteplase and cordyceps both increase anticoagulation. Modify Therapy/Monitor Closely.
- dabigatran
dabigatran and reteplase both increase anticoagulation. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.
- dalteparin
dalteparin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- danshen
reteplase and danshen both increase anticoagulation. Use Caution/Monitor.
- devil's claw
reteplase and devil's claw both increase anticoagulation. Use Caution/Monitor.
- diclofenac
diclofenac and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- diflunisal
diflunisal and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- dong quai
reteplase and dong quai both increase anticoagulation. Modify Therapy/Monitor Closely.
- enoxaparin
enoxaparin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- epoprostenol
reteplase and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.
- etodolac
etodolac and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- fennel
reteplase and fennel both increase anticoagulation. Modify Therapy/Monitor Closely.
- fenoprofen
fenoprofen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- feverfew
reteplase and feverfew both increase anticoagulation. Modify Therapy/Monitor Closely.
- fish oil
fish oil, reteplase. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .
- fish oil triglycerides
fish oil triglycerides will increase the level or effect of reteplase by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.
- flurbiprofen
flurbiprofen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- fondaparinux
fondaparinux and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- forskolin
reteplase and forskolin both increase anticoagulation. Modify Therapy/Monitor Closely.
- garlic
reteplase and garlic both increase anticoagulation. Modify Therapy/Monitor Closely.
- ginger
reteplase and ginger both increase anticoagulation. Modify Therapy/Monitor Closely.
- ginkgo biloba
reteplase and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.
- green tea
green tea, reteplase. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.
- heparin
heparin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- horse chestnut seed
reteplase and horse chestnut seed both increase anticoagulation. Modify Therapy/Monitor Closely.
- ibuprofen
ibuprofen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- ibuprofen IV
ibuprofen IV and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- imatinib
imatinib, reteplase. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents.
- indomethacin
indomethacin and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- ketoprofen
ketoprofen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- ketorolac
ketorolac and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- ketorolac intranasal
ketorolac intranasal and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.
- meclofenamate
meclofenamate and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- mefenamic acid
mefenamic acid and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- melatonin
melatonin increases effects of reteplase by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.
- meloxicam
meloxicam and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- mistletoe
reteplase increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- nabumetone
nabumetone and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- naproxen
naproxen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- nettle
reteplase increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- nitroglycerin rectal
nitroglycerin rectal decreases effects of reteplase by Other (see comment). Use Caution/Monitor. Comment: Caution should be observed in patients receiving nitroglycerin during t-PA therapy. IV administration of nitroglycerin decreases the thrombolytic effect of tissue-type plasminogen activator (t-PA). Plasma levels of t-PA are reduced when coadministered with nitroglycerin. .
- omega 3 carboxylic acids
omega 3 carboxylic acids, reteplase. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.
- omega 3 fatty acids
omega 3 fatty acids, reteplase. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .
- oxaprozin
oxaprozin and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- panax ginseng
reteplase and panax ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.
- pau d'arco
reteplase and pau d'arco both increase anticoagulation. Modify Therapy/Monitor Closely.
- phytoestrogens
reteplase and phytoestrogens both increase anticoagulation. Modify Therapy/Monitor Closely.
- piroxicam
piroxicam and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- reishi
reteplase and reishi both increase anticoagulation. Modify Therapy/Monitor Closely.
- rivaroxaban
rivaroxaban, reteplase. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.
- salicylates (non-asa)
salicylates (non-asa) and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- salsalate
salsalate and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- Siberian ginseng
reteplase and Siberian ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.
- sulindac
sulindac and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- ticagrelor
ticagrelor, reteplase. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.
- tolmetin
tolmetin and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- tranexamic acid oral
tranexamic acid oral, reteplase. Either decreases effects of the other by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.
- vorapaxar
reteplase, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.
- vortioxetine
reteplase, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.
- warfarin
reteplase increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.
Minor (1)
- ceftaroline
ceftaroline increases effects of reteplase by Other (see comment). Minor/Significance Unknown. Comment: Cephalosporins with a methylthiotetrazole (MTT) side ring (eg, cefotetan, cefoperazone) are more frequently associated with hypoprothrombinemic activity.
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
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
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.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
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
Images
Patient Handout
reteplase intravenous
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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