Usual Adult Dose for Myocardial Infarction

10 units administered over 2 minutes as an IV bolus as soon as possible after the onset of acute myocardial infarction (AMI) symptoms, followed 30 minutes later by a second 10 unit IV bolus injection also administered over 2 minutes.

If serious bleeding (not controllable by local pressure) occurs before the administration of the second bolus, terminate any concomitant anticoagulant therapy and do not administer the second reteplase bolus.

Half dose reteplase (5 units) has been used in the GUSTO V trial in combination with abciximab.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

Reteplase should be administered via an IV line in which no other medication is being simultaneously injected or infused. Do not add any other medications to the injection solution. If reteplase is to be injected through an IV line containing heparin, flush normal saline or D5W through the line before and after administering reteplase.

Reperfusion arrhythmias during therapy with reteplase can be a sign of successful coronary thrombolysis. These arrhythmias (e.g., sinus bradycardia, accelerated idioventricular rhythm, ventricular premature repolarizations, ventricular tachycardia) may also be seen during the natural course of acute myocardial infarction, and should be treated with appropriate antiarrhythmic measures. It is recommended that standard antiarrhythmia therapy for bradycardia and/or ventricular irritability be available during reteplase therapy.

Although reteplase has not been extensively studied in the treatment of ischemic stroke, according to AHA/ASA guidelines for the early management of ischemic stroke, use of a thrombolytic agent (i.e., recombinant tissue plasminogen activator; 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

• Is Activase the same as tPA?