• Acute myocardial infarction:
    • Accelerated Infusion < 67kg:
      • IV 15mg bolus over 1-2 minutes, then 0.75mg/kg/dose over 30min, then 0.5 mg/kg/dose over 60min
      • Max: 100mg/total dose
    • Accelerated Infusion > 67kg:
      • IV 15mg bolus over 1-2 minutes, then 50mg over 30min, then 35mg over 60min
      • Max: 100mg/total dose
    • 3 hour infusion <65 kg:
      • IV 0.075mg/kg/dose bolus over 1-2 minutes, then 0.675 mg/kg over 60min, then 0.5mg/kg over 120min
      • Max: 100mg/total dose
    • 3 hour infusion >65 kg:
      • IV 60mg over 60min, then 40mg over 120min
      • Max: 100 g/total dose
      • Given 6-10mg first dose as bolus, then remainder over 60min
  • Acute ischemic stroke:
    • ASAP within 3 hours of symptoms onset
    • Give 10% total dose IV (0.09 mg/kg/dose) x1, then remaining 90% (0.81 mg/kg/dose) over 60min
    • Max: 90 mg/total dose
    • Discontinue if pre-treatment INR >1.7 or aPTT increases
    • May give within 3-4.5 hours of symptom onset if patient <81 years without DM and prior stroke history, no anticoagulant use, NIHSS score <26 and ischemic injury <33% MCA territory on imaging
  • Acute massive pulmonary embolism:
    • IV 100mg over 2 hours

Injection: 50mg per vial

  • Reconstitute no more than 8 hours before use
  • Avoid excessive agitation during dilution. Mix by gently swirling and/or slow inversion
  • Slight foaming is not unusual; let it stand undisturbed for several minutes to allow large bubbles to dissipate

Fibrinolytic

It binds to fibrin and converts tissue plasminogen to plasmin which degrades fibrin and fibrinogen, promoting fibrinolysis.

  • Bleeding
  • Intracranial hemorrhage
  • Thromboembolism
  • Cholesterol embolism
  • Hypersensitivity reactions
  • Anaphylaxis
  • Hypersensitivity to components
  • Active internal bleeding
  • Intracranial aneurysm or AVM
  • Intracranial neoplasm
  • Intracranial or intraspinal surgery within 3 months
  • Serious head trauma within 3 months
  • Ischemic stroke within prior 3 months
  • Bleeding diathesis
  • Severe/uncontrolled hypertension
  • Aortic dissection, known or suspected (stroke or MI use)
  • Intracranial hemorrhage (stroke use)
  • Subarachnoid hemorrhage (stroke use)
  • GI bleeding within 21 days (stroke use)
  • GU bleeding within 21 days (stroke use)
  • Infective endocarditis (stroke use)
  • Mifepristone
  • Enoxaparin
  • Rivaroxaban
  • Fondaparinux

                                   Drug Status

Availability Prescription only
Pregnancy Category C
Breastfeeding Safe to use
Schedule Not controlled
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Actilys 50mg Injection 1’s Boehringer Ingelheim Surgipharm Ltd