Drug reference

Alteplase

Recombinant tissue plasminogen activator (fibrinolytic) · Thrombolytic

START

Stroke: 0.9 mg/kg IV (10% bolus + 60-min infusion)

TYPICAL MAX

90 mg (stroke); 100 mg (STEMI/PE)

STOP IF

Any intracranial bleed signs, angioedema, or major haemorrhage

WATCH

Neuro status, BP <180/105, bleeding, airway (angioedema)

CDSCO approvedSchedule HATC B01AD02

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 3min · fibrinolysis
PEAK: 1h · end infusion
t½: 5min · t½ ~5 min
DURATION: 3h · clotting recovery

EXCRETION

Hepatic proteolysis; rapid plasma clearance

route + CYP

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Use only if life-threatening and benefit outweighs risk.

FDA category + note

Top interactionssee all 12 →

Tranexamic AcidContraindicatedDatabaseDDInter
BenazeprilSevereTextbookG&G 14e · p600
AbciximabSevereDatabaseDDInter
AcalabrutinibSevereDatabaseDDInter

Available in India

2 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Recombinant human tPA that binds fibrin and converts entrapped plasminogen to plasmin, producing fibrin-selective clot lysis at the thrombus.

Indications

Acute ischaemic stroke (within 4.5 h)Acute STEMIAcute massive/submassive pulmonary embolismOccluded central venous catheters

Dosing

Adult: Ischaemic stroke: 0.9 mg/kg IV (max 90 mg) — 10% bolus, rest over 60 min. STEMI: accelerated weight-based ≤100 mg over 90 min. PE: 100 mg IV over 2 h.
Pediatric: Catheter clearance: 0.5–2 mg per lumen (specialist).
Renal adjustment: No dose adjustment.
Hepatic adjustment: No specific adjustment; bleeding risk in severe hepatic disease.
Geriatric: No dose change; higher ICH risk (assess carefully).
Max dose: 90 mg (stroke); 100 mg (STEMI/PE)

Pharmacokinetics

Onset

Fibrinolysis within minutes

Peak effect

End of infusion

Duration

Fibrinolytic effect short; clotting recovers hours

Half-life

Initial ~4–5 min; terminal ~40 min

Bioavailability

IV 100%

Protein binding

Not applicable (protein)

Metabolism

Hepatic clearance (proteolysis)

Excretion

Hepatic metabolism; rapid plasma clearance

Contraindications

Active internal bleeding
Recent intracranial haemorrhage / known AVM / aneurysm / neoplasm
Recent intracranial or spinal surgery/trauma (<3 months)
Severe uncontrolled hypertension
Bleeding diathesis; (stroke) recent stroke or BP >185/110

Side effects

Common

Bleeding (puncture sites, GI, GU)HypotensionNauseaFever

Serious

Intracranial haemorrhage
Major systemic haemorrhage
Angioedema (orolingual, esp. with ACE inhibitors)
Reperfusion arrhythmias
Cholesterol embolisation

Pregnancy & lactation

Pregnancy

Use only if life-threatening and benefit outweighs risk.

Lactation

No data; short half-life — brief interruption reasonable.

Drug interactions

Tranexamic Acid

Contraindicated

Database

Tranexamic acid inhibits fibrinolysis, directly counteracting the thrombolytic effect of alteplase. This renders alteplase ineffective and may increase the risk of re-thrombosis.

Concomitant use is contraindicated. Tranexamic acid should not be administered with fibrinolytic agents.

Source: DDInter

Benazepril

Severe

Textbook

Increased risk of angioedema.

Avoid combination.

Source: G&G 14e · p600

Abciximab

Severe

Database

Clinical effect not specified

Source: DDInter

Acalabrutinib

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Anisindione

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Anticoagulants

Severe

Database

Additive bleeding

Strict protocol timing; monitor; weigh risk

Source: Kimi deep-research + Cla

Antiplatelets

Severe

Database

Additive bleeding

Per protocol; monitor closely

Source: Kimi deep-research + Cla

Apixaban

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Ardeparin

Severe

Database

Clinical effect not specified

Source: DDInter

Argatroban

Severe

Database

Clinical effect not specified

Source: DDInter

Avapritinib

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Betrixaban

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Related guidelines

Acute ischaemic stroke

ISN_INDIA · Neurology · 2022

Acute ischaemic stroke

AHA · Neurology · 2019

Extrapulmonary tuberculosis

ICMR · Infectious Diseases · 2022

Venous thromboembolism prophylaxis

ASH · Haematology · 2018

Chronic obstructive pulmonary disease

ICS · Pulmonology · 2022

Ask House about Alteplase

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Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, BNF·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20