reteplase (Rx)

Brand and Other Names:Retavase
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 10.4 units (18.1mg)

Acute Myocardial Infarction

10 units IV bolus (over 2 minutes), THEN

Second dose given 30 minutes after first (for total cumulative dose of 20 units)

Treatment should be initiated ASAP after onset of AMI

Give each bolus injection via an IV line in which no other medication is being simultaneously injected or infused

Safety & efficacy not established

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Interactions

Interaction Checker

and reteplase

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (2)

            • defibrotide

              defibrotide increases effects of reteplase by pharmacodynamic synergism. Contraindicated. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. This does not include use for routine maintenance or reopening of central venous lines.

            • prothrombin complex concentrate, human

              reteplase, prothrombin complex concentrate, human. pharmacodynamic antagonism. Contraindicated.

            Serious - Use Alternative (3)

            • apixaban

              reteplase and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • tenecteplase

              reteplase and tenecteplase both increase anticoagulation. Avoid or Use Alternate Drug.

            • zanubrutinib

              reteplase, zanubrutinib. Either increases effects of the other by anticoagulation. Avoid or Use Alternate Drug. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

            Monitor Closely (77)

            • agrimony

              reteplase and agrimony both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alfalfa

              reteplase and alfalfa both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alteplase

              alteplase and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • American ginseng

              reteplase and American ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • anamu

              reteplase and anamu both increase anticoagulation. Use Caution/Monitor.

            • antithrombin alfa

              antithrombin alfa and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • antithrombin III

              antithrombin III and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • argatroban

              argatroban and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • aspirin

              aspirin, reteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • aspirin rectal

              aspirin rectal and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, reteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • azficel-T

              azficel-T, reteplase. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.

            • bivalirudin

              bivalirudin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • caplacizumab

              caplacizumab, reteplase. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            • celecoxib

              celecoxib and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cinnamon

              reteplase and cinnamon both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cordyceps

              reteplase and cordyceps both increase anticoagulation. Modify Therapy/Monitor Closely.

            • dabigatran

              dabigatran and reteplase both increase anticoagulation. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

            • dalteparin

              dalteparin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • danshen

              reteplase and danshen both increase anticoagulation. Use Caution/Monitor.

            • devil's claw

              reteplase and devil's claw both increase anticoagulation. Use Caution/Monitor.

            • diclofenac

              diclofenac and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • diflunisal

              diflunisal and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • dong quai

              reteplase and dong quai both increase anticoagulation. Modify Therapy/Monitor Closely.

            • enoxaparin

              enoxaparin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • epoprostenol

              reteplase and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

            • etodolac

              etodolac and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • fennel

              reteplase and fennel both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenoprofen

              fenoprofen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • feverfew

              reteplase and feverfew both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fish oil

              fish oil, reteplase. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of reteplase by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

            • flurbiprofen

              flurbiprofen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • fondaparinux

              fondaparinux and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • forskolin

              reteplase and forskolin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • garlic

              reteplase and garlic both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ginger

              reteplase and ginger both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ginkgo biloba

              reteplase and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

            • green tea

              green tea, reteplase. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

            • heparin

              heparin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • horse chestnut seed

              reteplase and horse chestnut seed both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ibuprofen

              ibuprofen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ibuprofen IV

              ibuprofen IV and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • imatinib

              imatinib, reteplase. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents.

            • indomethacin

              indomethacin and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ketoprofen

              ketoprofen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ketorolac

              ketorolac and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ketorolac intranasal

              ketorolac intranasal and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • meclofenamate

              meclofenamate and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • mefenamic acid

              mefenamic acid and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • melatonin

              melatonin increases effects of reteplase by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

            • meloxicam

              meloxicam and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • mistletoe

              reteplase increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • nabumetone

              nabumetone and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • naproxen

              naproxen and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • nettle

              reteplase increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • nitroglycerin rectal

              nitroglycerin rectal decreases effects of reteplase by Other (see comment). Use Caution/Monitor. Comment: Caution should be observed in patients receiving nitroglycerin during t-PA therapy. IV administration of nitroglycerin decreases the thrombolytic effect of tissue-type plasminogen activator (t-PA). Plasma levels of t-PA are reduced when coadministered with nitroglycerin. .

            • omega 3 carboxylic acids

              omega 3 carboxylic acids, reteplase. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • omega 3 fatty acids

              omega 3 fatty acids, reteplase. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • oxaprozin

              oxaprozin and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • panax ginseng

              reteplase and panax ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • pau d'arco

              reteplase and pau d'arco both increase anticoagulation. Modify Therapy/Monitor Closely.

            • phytoestrogens

              reteplase and phytoestrogens both increase anticoagulation. Modify Therapy/Monitor Closely.

            • piroxicam

              piroxicam and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • reishi

              reteplase and reishi both increase anticoagulation. Modify Therapy/Monitor Closely.

            • rivaroxaban

              rivaroxaban, reteplase. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

            • salicylates (non-asa)

              salicylates (non-asa) and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • salsalate

              salsalate and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • Siberian ginseng

              reteplase and Siberian ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulindac

              sulindac and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ticagrelor

              ticagrelor, reteplase. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.

            • tolmetin

              tolmetin and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • tranexamic acid oral

              tranexamic acid oral, reteplase. Either decreases effects of the other by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

            • vorapaxar

              reteplase, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • vortioxetine

              reteplase, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            • warfarin

              warfarin and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            Minor (1)

            • ceftaroline

              ceftaroline increases effects of reteplase by Other (see comment). Minor/Significance Unknown. Comment: Cephalosporins with a methylthiotetrazole (MTT) side ring (eg, cefotetan, cefoperazone) are more frequently associated with hypoprothrombinemic activity.

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            Adverse Effects

            Frequency Not Defined

            Reperfusion arrhythmias, hypotension

            Dizziness, fever, severe headache

            Anemia, cholesterol embolization, GI/GU bleeding, intracranial hemorrhage

            Nausea, vomiting

            Cardiac reinfarction

            Cardiogenic shock

            Muscle pain

            Allergic reaction, injection site reaction

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            Warnings

            Contraindications

            Hypersensitivity

            Active bleeding, recent CVA, recent intracranial or intraspinal surgery or trauma, intracranial neoplasm, AVM, aneurysm, bleeding diathesis, severe uncontrolled HTN

            See thrombolytic indications/contraindications

            Cautions

            Recent major surgery, cerebrovascular disease, recent GI or GU bleeding, HTN, acute pericarditis, hemostatic defects, severe thrombophlebitis, severe hepatic/renal dysfunction, currently receiving oral anticoagulants, diabetic hemorrhagic retinopathy, elderly

            Monitor potential bleeding sites

            Cholesterol embolism reported

            Ischemic Stroke: may have no benefit if used after 3 hr of onset

            Current use of warfarin and INR in high range may increase bleeding risk

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Not known whether drug crosses into breast milk, unlikely patients will be concerned about nursing in indicated circumstances

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Reteplase is the r-PA (recombinant plasminogen activator) with nonglycosylated deletion mutant of wild-type tissue plasminogen activator (tPA); has less high-affinity fibrin binding, longer half-life, & greater thrombolytic potency than tPA

            Promotes thrombolysis by converting plasminogen to plasmin which degrades fibrin & fibrinogen

            Pharmacokinetics

            Half-Life: 13-16 min

            Onset: Coronary thrombolysis occurs in 30 min, reaches peak response at 30-90 min

            Metabolism: Inactivated by blood components C1 inactivator, alfa-1-antitrypsin, alfa-2-antiplasmin

            Excretion: Urine and feces

            Plasma clearance: 250-450 mL/min

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            Administration

            IV Incompatibilities

            Y-site: bivalirudin

            Additive, Syringe, Y-site: heparin

            IV Preparation

            Reconstitute using diluent, needle, syringe & dispensing pin provided to obtain 1 U/mL soln

            IV Administration

            Bolus over 2 min

            Do not admin solutions that are discolored or contain precipitate

            Slight foaming may occur

            • May need to stand undisturbed for several minutes to dissipate bubbles

            Flush before & after each bolus

            Line to contain D5W

            Stability

            Stable for 4 hr at room temp

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            Images

            No images available for this drug.
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            Patient Handout

            Patient Education
            reteplase intravenous

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.