Reteplase (retavase)

WHAT IT'S FOR:

Improving heart function and reducing long-term effects of a heart attack.

Reteplase (retavase)

MECHANISM OF ACTION (1):

Reteplase (retavase) is a tissue plasminogen activator. It works by retaining fibrin specificity and preferentially converts clot-bound plasminogen, rather than free (release) the pasminogen.

Compared to alteplase tPA, reteplase has a lower fibrin binding which may translate into improved clot penetration.

Reteplase (retavase)

MECHANISM OF ACTION (2):

Retavase is a recombinant plasminogen activator which catalyzes the cleavage of endogenous plasminogen to generate plasmin.

Reteplase (retavase)

MECHANISM OF ACTION (3):

Plasmin in turn degrades the fibrin matrix of the thrombus, thereby exerting its thrombolytic action.

Reteplase (retavase)

DOSAGE & ADMINISTRATION (1): 

Potency is expressed in Units using a reference standard which is specific for retavase and is NOT comparable with units used for other thrombolytic agents.

No other medication should be added to the injection solution containing retavase (reteplase).

Reteplase (retavase)

DOSAGE & ADMINISTRATION (2): 

It is administered as a 10 + 10 unit double-bolus injection. Two 10 unit bolus injections are required for a complete treatment.

Reteplase (retavase)

DOSAGE & ADMINISTRATION (3): 

Each bolus is administered as an intravenous injection over 2 minutes. The second bolus is given 30 minutes after initiation of the first bolus injection.

Reteplase (retavase)

DOSAGE & ADMINISTRATION (4): 

Each bolus injection should be given via an intravenous line in which no other medication is being simultaneously injected or infused.

Reteplase (retavase)

VIP NOTE:

Heparin and retavase are incompatible when combined in solution. Do NOT administer heparin and retavase simultaneously in the same intravenous line.

Reteplase (retavase)

PRECAUTIONS:

If retavase is to be injected through an intravenous line containing heparin, a normal saline or 5% dextrose (D5W) solution should be flushed through the line prior to and following the retavase injection.

Reteplase (retavase)

PRECAUTIONS: 

In addition, the second bolus injection of retavase should not be given if the serious bleeding occurs before it is administered.

Reteplase (retavase)

PRECAUTIONS:

In the event of serious bleeding, any concomitant heparin should be terminated immediately.

Heparin effects can be reversed by protamine.

Reteplase (retavase)

RECONSTITUTION:  

Retavase requires the practitioner to follow a very detailed and specific procedure to reconstitute the solution prior to injection.

Reteplase (retavase)

Reconstitution:

Reconstitution should be carried out using the diluent and dispensing pin provided with retavase. It is important that retavase be reconstituted only with the supplied Sterile Water for Injection, USP (without preservatives).

Reteplase (retavase)

RECONSTITUTION:

Because retavase contains no antibacterial preservatives, it should be reconstituted immediately before use. When reconstituted as directed, the solution may be used within 4 hours when stored at 2-30°C (36-86°F). Prior to administration, the product should

be visually inspected for particulate matter and discoloration.

Reteplase (retavase)

Reconstitution

The reconstituted preparation results in a colorless solution containing retavase 1 unit/mL. Slight foaming upon reconstitution is not unusual; allowing the vial to stand undisturbed for several minutes is usually sufficient to allow dissipation of any large bubbles.

Reteplase (retavase)

PRECAUTIONS:  

Standard management of myocardial infarction should be  implemented concomitantly with retavase treatment.

Arterial and venous punctures should be minimized.

Reteplase (retavase)

CONTRAINDICATIONS:

Because thrombolytic therapy increases the risk of bleeding, retavase is contraindicated in the  following situations: 

• Active internal bleeding
• History of cerebrovascular accident
• Recent intracranial or intraspinal
• Intracranial neoplasm, arteriovenous
• Known bleeding diathesis
• Severe uncontrolled hypertension

Streptokinase (streptase)

WHAT IT'S FOR:

To treat the following conditions:

• Acute Evolving Transmural Myocardial Infarction
• Pulmonary Embolism
• Deep Vein Thrombosis
• Arterial Thrombosis or Embolism
• Occlusion of Arteriovenous Cannulae

Streptokinase (streptase)

DOSAGE & ADMINISTRATION:

Acute Evolving Transmural Myocardial Infarction: 

• Administer streptokinase as soon as possible after onset of symptoms.
• The greatest benefit in mortality reduction was observed when Streptokinase was administered within four hours, but
• statistically significant benefit has been reported up to 24 hours.

Streptokinase (streptase)

DOSAGE:

Dosage for Acute Evolving Transmural Myocardial Infarction

Streptokinase (streptase)

DOSAGE:

Pulmonary Embolism, Deep Vein Thrombosis, Arterial Thrombosis or Embolism 

Streptokinase (streptase)

PROCEDURE:

Arteriovenous Cannulae Occlusion: Before using Streptase, Streptokinase:

• An attempt should be made to clear the cannula by careful syringe technique, using heparinized saline solution.
• If adequate flow is not re-established, Streptokinase may be employed.
• Allow the effect of any pretreatment anticoagulants to diminish.
• Instill 250,000 IU Streptokinase in 2 mL of solution into each occluded limb of the cannula slowly.
• Clamp off cannula limb(s) for 2 hours.
• Observe the patient closely for possible adverse effects.
• After treatment:
  • Aspirate contents of infused cannula limb(s),
  • Flush with saline,
  • Reconnect cannula.

Streptokinase (streptase)

Side Effects:

Severe internal bleeding involving:

• Gastrointestinal (including hepatic bleeding),
• Genitourinary,
• Retroperitoneal, or
• Intracerebral sites has occurred and has resulted in fatalities.

In the treatment of acute myocardial infarction with intravenous streptokinase, the GISSI and ISIS-2 studies reported a rate of major bleeding (requiring transfusion) of 0.3-0.5%. However, rates as high as 16% have been reported in studies which required administration of anticoagulants and invasive procedures.

Streptokinase (streptase)

Allergic Reactions:

• Fever and shivering;
• Anaphylactic and anaphylactoid reactions ranging in severity from
  • Minor breathing difficulty to
  • Bronchospasm,
  • Periorbital swelling or
  • Angioneurotic edema have been observed rarely.
• Other milder allergic effects such as urticaria, itching, flushing, nausea, headache and musculoskeletal pain have also been observed, as have delayed hypersensitivity reactions such as vasculitis and interstital nephritis.
• Anaphylactic shock is very rare.

Streptokinase (streptase)

PRECAUTIONS:

There have been rare cases where streptase, streptokinase, has been administered for:

• Suspected acute myocardial infarction (MI)subsequently diagnosed as pancreatitis.
• Fatalities have occurred under these circumstances.

Streptokinase (streptase)

CONTRAINDICATIONS:

Because thrombolytic therapy increases the risk of bleeding, streptase, streptokinase, is contraindicated in the following situations:

• active internal bleeding
• recent (within 2 months) cerebrovascular accident, intracranial or intraspinal surgery 
• intracranial neoplasm
• severe uncontrolled hypertension