Reconstitute Activase® (alteplase) immediately before administration and monitor patients
Review these general guidelines for Activase reconstitution
The recommended dose of Activase is 0.9 mg/kg (not to exceed 90 mg
total dose) infused over 60 minutes with 10% of the total dose
administered as an initial bolus over 1 minute.
Follow the steps below for reconstituting 100-mg vials. 5
- Reconstitute Activase immediately before administration, using only Sterile Water for Injection (SWFI) U.S. Pharmacopeia (USP) without preservatives as well as the transfer device. Both are provided in the Activase package. Do not use Bacteriostatic Water for Injection, USP.
- Begin by assembling the Activase vial; the vial of SWFI, USP; and the transfer device included in the Activase package. Also gather alcohol swabs and 2 syringes—1 for the bolus dose and 1 for the discarded quantity of Activase.
- Reconstitution should be carried out using the transfer device provided and by adding the contents of the 100‑mL vial of SWFI to the 100-mg vial of Activase powder. Reconstitute Activase immediately before administration, using aseptic technique at all times.
Remove protective caps and swab the top of each vial with an alcohol wipe to reduce the risk of contamination.
Remove one of the protective caps from the transfer device and
insert the piercing pin vertically into the center of the stopper of
the SWFI vial, keeping the vial upright. Holding the Activase vial
upside down, position it so that the center of the stopper is directly
over the exposed pin of the transfer device. Push vial down onto the
transfer device, ensuring that the piercing pin is inserted through
the center of the Activase vial stopper.
INSERT TRANSFER PIN IN SWFI VIAL
INSERT ACTIVASE VIAL ON OTHER END OF PIN
Invert the 2 vials, so that the vial of Activase is on the bottom
(upright) and the vial of SWFI is upside down. Allow the entire
contents of the vial of SWFI to flow down through the transfer device
into the vial containing Activase. Approximately 0.5 mL of SWFI will
remain in the diluent vial. Remove the transfer device and the empty
SWFI vial from the Activase vial. Safely discard both the transfer
device and the empty diluent vial according to institutional
DISCARD PIN AND SWFI VIAL
Mix the solution with a gentle swirl. DO NOT SHAKE. Slight
foaming of the solution is normal. Let the solution stand undisturbed
for several minutes to allow any large bubbles to dissipate. This
preparation will result in a colorless to pale yellow transparent
solution containing Activase at a concentration of 1 mg/mL. Visually
inspect the Activase solution for particulate matter and discoloration
LET IT SETTLE (SEVERAL MINUTES)
The solution may be used for intravenous administration within 8 hours following reconstitution when stored between 2-30°C (36-86°F). Do not add other medication to solutions containing Activase. Any unused solution should be discarded.
During and following Activase administration for the treatment of AIS, frequently monitor and control blood pressure.
In patients without recent use of oral anticoagulants or heparin, Activase treatment can be initiated prior to the availability of coagulation study results. Discontinue Activase if the pretreatment International Normalized Ratio (INR) is greater than 1.7 or the activated partial thromboplastin time (aPTT) is elevated.