Usual Adult Dose for Myocardial Infarction

For accelerated infusion method:
Over 67 kg: 100 mg administered as a 15 mg IV bolus followed by 50 mg infused over the next 30 minutes and then 35 mg infused over the next 60 minutes.
67 or less kg: 15 mg IV bolus, followed by 0.75 mg/kg (not to exceed 50 mg) infused over the next 30 minutes and then 0.5 mg/kg (not to exceed 35 mg) infused over the next 60 minutes.

For 3 hour infusion method:
Over 65 kg: 100 mg administered as 60 mg IV in the first hour (with 6 to 10 mg of it given as an IV bolus over 1 to 2 minutes), followed by 20 mg/hour IV during hours 2 and 3.
Less than 65 kg: 1.25 mg/kg administered as 0.75 mg/kg IV in the first hour (with 6 to 10 mg of it given as an IV bolus over 1 to 2 minutes), followed by 0.25 mg/kg/hour during hours 2 and 3. Heparin is usually given during and following administration of alteplase. Aspirin and/or dipyridamole have been given during and/or following heparin treatment.

Usual Adult Dose for Pulmonary Embolism

50 mg/hour IV over 2 hours for a total dose of 100 mg. Heparin is usually started near the end or immediately following this infusion when partial thromboplastin time or thrombin time falls to twice the normal value or less.

Usual Adult Dose for Ischemic Stroke

0.9 mg/kg (up to 90 mg) IV over 60 minutes with 10% of the total dose administered as an initial IV bolus over the first minute.

Usual Adult Dose for Thrombotic/Thromboembolic Disorder

Occluded central venous catheter:
Manufacturer's recommendations (CathFlo Activase): Patients 30 or more kg: 2 mg in 2 mL; may instill second dose if catheter remains occluded after 2 hour dwell time. A recent study using escalating doses of 0.5 mg, 1 mg, and 2 mg (60 minute dwell time) found that 86.2% of catheters were cleared with the 0.5 mg dose.

Usual Pediatric Dose for Thrombotic/Thromboembolic Disorder

Occluded IV catheter: Infuse in to catheter, do not infuse in to patient: Dose listed is per lumen; for multilumen catheters, treat one lumen at a time; dose should always be aspirated out of catheter after dwell.
Manufacturer's recommendations (CathFlo Activase):
Central venous catheter: post natal age 14 days or older: Use a 1 mg/mL concentration; instill a volume equal to 110% of the internal lumen volume of the catheter; do not exceed 2 mg in 2 mL; leave in lumen for up to 2 hours, then aspirate out of catheter; may instill a second dose if catheter remains occluded after 2 hour dwell time.
Alternative dosing:
Central venous catheter: 0.5 mg diluted in NS to a volume equal to the internal volume of the lumen; instill in each lumen over 1-2 minutes; leave in lumen for 1 to 2 hours, then aspirate out of catheter; flush catheter with NS.
or
Central venous catheter: 0.25 to 0.5 mg/mL solution; instill a volume to fill the catheter; leave in lumen for up to 2 hours, then aspirate out of catheter.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

A dose of 150 mg of alteplase should not be used for the treatment of acute myocardial infarction because it has been associated with an increase in intracranial bleeding.

Dialysis

Data not available

Other Comments

Administer alteplase as soon as possible after the onset of acute myocardial infarction symptoms.

According to AHA/ASA guidelines for the early management of ischemic stroke, use of recombinant tissue plasminogen activator (i.e., alteplase) within 3 hours of stroke symptom onset is associated with improved outcomes. Earlier treatment (i.e., within 90 minutes) may be more likely to result in a favorable outcome. However, the upper limit of the treatment window may be as late as 5 to 6 hours after symptom onset.

Frequently asked questions

• What is the antidote for Activase?
• How is Activase (alteplase) given/administered?