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Alteplase monograph errata for Lexi-Comp Drug Information Handbook 7th Edition


The alteplase monograph in the 7th edition of the Lexi-Comp Drug Information Handbook has a dosing error that could lead to a medication error. Under dosing for coronary artery thrombi, the book recommends a total dose of 100 mg over 1.5 hours. However, it recommends giving 15 mg over 1-2 minutes, 50 mg over 30 minutes and 35 mg per hour for the next 2 hours. Such a dosing schedule would result in administering a total of 135 mg over 2.5 hours. The correct alteplase dose for coronary artery thrombosis is 100 mg over 1.5 hours to be given as 15 mg over 1-2 minutes, 50 mg over 30 minutes and 35 mg over the next 60 minutes. Additionally, the monograph lists a total dose of 1.25 mg/kg for patients weighing less than 65 kg. This is also an error in the monograph. Patients less than or equal to 67 kg (not 65 kg) should get the 1.25 mg/kg/total dose as a 15 mg bolus over 1-2 minutes, 0.75 mg/kg (not to exceed 50 mg) over the next 30 minutes, and then 0.5 mg/kg over the next 60 minutes (not to exceed 35 mg).

Here is the updated information that will appear in the next edition:

Coronary artery thrombi:
I.V.:Front loading dose:
Total dose is 100 mg over 1.5 hours (for patients who weigh less than or equal to 67 kg, use 1.25 mg/kg/total dose). Add this dose to a 100 mL bag of 0.9% sodium chloride for a total volume of 200ml. Infuse 15 mg (30 mL) over 1-2 minutes;

infuse 50 mg (100 mL) over 30 minutes.

Begin heparin 5000 - 10,000 unit bolus followed by continuous infusion of 1000 units/hour.
Infuse the remaining 35 mg (70 mL) of alteplase over the next hour. For < or = 67 kg: 15 mg I.V. bolus over 1 - 2 minutes. Infuse 0.75 mg/kg (not to exceed 50 mg) over next 30 minutes and then 0.5 mg/kg over next 60 minutes(not to exceed 35 mg)

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