Retavase (reteplase) dosing, indications, interactions, adverse effects, and more

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Sections reteplase
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
Administration
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Dosing & Uses

AdultPediatric

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

Interaction Checker

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Interactions Found

Contraindicated

Serious - Use Alternative

Significant - Monitor Closely

Minor

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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

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.

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

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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Patient Handout

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.

Create Your List of Plans

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.

View explanations for tiers and restrictions

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.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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Sections reteplase
Dosing & Uses
Interactions
Adverse Effects
Warnings
Pregnancy
Pharmacology
Administration
Images
Patient Handout
Formulary

reteplase (Rx)