Rapilysin

reteplase, recombinant

Rapilysin (UK), Retavase

Pharmacologic class: Tissue plasminogen activator

Therapeutic class: Thrombolytic enzyme

Pregnancy risk category C

Action

Converts plasminogen to plasmin, which in turn breaks down fibrin and fibrinogen, thereby dissolving thrombus

Availability

Injection: Retavase Half-Kit-one vial of 10.4 units (18.1 mg)/vial; Retavase Kit-two vials of 10.4 units (18.1 mg)/vial

Indications and dosages

Acute myocardial infarction

Adults: 10 units by I.V. bolus over 2 minutes, repeated in 30 minutes

Off-label uses

• Pulmonary embolism

Contraindications

• Hypersensitivity to drug or alteplase
• Active internal bleeding
• Bleeding diathesis
• Recent intracranial or intraspinal surgery or trauma
• Intracranial neoplasm
• Arteriovenous malformation or aneurysm
• Severe uncontrolled hypertension
• History of cerebrovascular accident

Precautions

Use cautiously in:
• previous puncture of noncompressible vessels, major surgery, obstetric delivery, organ biopsy, trauma, hypertension, conditions that may cause left-sided heart thrombus (including mitral stenosis), acute pericarditis, subacute bacterial endocarditis, hemostatic defects, diabetic hemorrhagic retinopathy, cerebrovascular disease, severe hepatic or renal dysfunction, septic thrombophlebitis or occluded AV cannula at a seriously infected site, other conditions in which bleeding poses a significant hazard
• concurrent use of oral anticoagulants (such as warfarin)
• patients older than age 75
• pregnant or breastfeeding patients.

Administration

If patient shows signs or symptoms of bleeding or anaphylaxis after first bolus dose, withhold second bolus and contact prescriber immediately.
• Use only diluent supplied (preservative-free sterile water for injection) to reconstitute drug into colorless solution of 1 unit/ml.
• If drug foams, let it sit until foam subsides.
• Don't use solution if it is discolored or contains visible precipitates.
• Don't give with other drugs in same I.V. line. Know that drug is incompatible with heparin.

Adverse reactions

CNS: intracranial hemorrhage

CV: arrhythmias, hemorrhage

GI: nausea, vomiting, GI bleeding

GU: hematuria

Hematologic: anemia, bleeding tendency

Other: fever, bleeding at puncture sites

Interactions

Drug-drug.Anticoagulants, indomethacin, phenylbutazone, platelet aggregation inhibitors (such as abciximab, aspirin, dipyridamole): increased risk of bleeding

Drug-diagnostic tests.Hemoglobin: decreased level

International Normalized Ratio, partial thromboplastin time, prothrombin time: increased

Drug-herbs.Ginkgo, many other herbs: increased risk of bleeding

Patient monitoring

Check closely for signs and symptoms of bleeding in all body systems. Monitor coagulation studies and CBC.
• Monitor ECG for arrhythmias caused by coronary thrombolysis.
• Assess neurologic status to detect early signs and symptoms of intracranial hemorrhage.

Patient teaching

• Teach patient about drug's anticoagulant effect. Review safety measures to avoid injury, which can cause uncontrolled bleeding.

Instruct patient to immediately report signs and symptoms of bleeding problems.
• Tell patient he'll undergo frequent blood testing during therapy.

Rapilysin

A brand name for RETEPLASE.
References in periodicals archive ?
Reteplase is a recombinant protein and the active ingredient in the medicinal product Rapilysin used for the thrombolytic treatment of myocardial infarction.
Actavis is the holder of the rights to the Reteplase production process and the distribution of Rapilysin in Europe and worldwide excluding the US and Canada.