container; incompatible with polyvinyl chloride giving sets
or containers; protect infusion from light. Polyethylene,
polypropylene, or glass apparatus should be used. PVC
should be avoided.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Solution for infusion
▶Nimotop(Bayer Plc)
Nimodipine 200 microgram per 1 mlNimotop 0. 02 % solution for
infusion 50 ml vials| 5 vialP£ 68. 00 (Hospital only)
Tablet
▶Nimotop(Bayer Plc)
Nimodipine 30 mgNimotop 30 mg tablets| 100 tabletP£ 40. 003 Blood clots
3.1 Blocked catheters and lines
ANTITHROMBOTIC DRUGS›TISSUE
PLASMINOGEN ACTIVATORSFibrinolytic drugs
Overview
Alteplase below, streptokinase p. 89 and urokinase p. 89 are
used in children to dissolve intravascular thrombi and
unblock occluded arteriovenous shunts, catheters, and
indwelling central lines blocked withfibrin clots. Treatment
should be started as soon as possible after a clot has formed
and discontinued once a pulse in the affected limb is
detected, or the shunt or catheter unblocked.
The safety and efficacy of treatment remains uncertain,
especially in neonates. Afibrinolytic drug is probably only
appropriate where arterial occlusion threatens ischaemic
damage; an anticoagulant may stop the clot getting bigger.
Alteplase is the preferredfibrinolytic in children and
neonates; there is less risk of adverse effects including
allergic reactions.Fibrinolytics f
lDRUG ACTIONFibrinolytic drugs act as thrombolytics by
activating plasminogen to form plasmin, which degrades
fibrin and so breaks up thrombi.
lCONTRA-INDICATIONSAcute pancreatitis.aneurysm.
arteriovenous malformation.bacterial endocarditis.
bleeding diatheses.coagulation defects.neoplasm with
risk of haemorrhage.pericarditis.recent haemorrhage.
recent surgery (including dental extraction).recent
trauma.severe hypertension
lCAUTIONSConditions with an increased risk of
haemorrhage.hypertension.risk of bleeding (including
that from venepuncture or invasive procedures)
lSIDE-EFFECTS
▶Common or very commonAnaphylactic reaction.angina
pectoris.cardiac arrest.cardiogenic shock.chills.CNS
haemorrhage.ecchymosis.fever.haemorrhage.
haemorrhagic stroke.heart failure.hypotension.
ischaemia recurrent (when used in myocardial infarction).
nausea.pericarditis.pulmonary oedema.vomiting
▶UncommonAphasia.mitral valve incompetence.
myocardial rupture.pericardial disorders.reperfusion
arrhythmia (when used in myocardial infarction).seizure
SIDE-EFFECTS, FURTHER INFORMATIONSerious bleeding
calls for discontinuation of the thrombolytic and mayrequire administration of coagulation factors and
antifibrinolytic drugs.
lPREGNANCYThrombolytic drugs can possibly lead to
premature separation of the placenta in thefirst 18 weeks
of pregnancy. There is also a risk of maternal haemorrhage
throughout pregnancy and post-partum, and also a
theoretical risk of fetal haemorrhage throughout
pregnancy.
lHEPATIC IMPAIRMENTAvoid in severe hepatic impairment
as there is an increased risk of bleeding.eiiiiFaboveAlteplase
(rt-PA; Tissue-type plasminogen activator)
lINDICATIONS AND DOSE
Intravascular thrombosis
▶BY INTRAVENOUS INFUSION
▶Neonate: 100 – 500 micrograms/kg/hour for 3 – 6 hours,
use ultrasound assessment to monitor effect before
considering a second course of treatment (consult local
protocol).▶Child: 100 – 500 micrograms/kg/hour for 3 – 6 hours, use
ultrasound assessment to monitor effect before
considering a second course of treatment; maximum
100 mg per day
ACTILYSE CATHFLO®
Thrombolytic treatment of occluded central venous access
devices (including those used for haemodialysis)
▶BY INTRAVENOUS INJECTION
▶Child:(consult product literature)lUNLICENSED USEActilyse®not licensed for use in
children.
lCONTRA-INDICATIONSOesophageal varices.recent
delivery.recent ulcerative gastro-intestinal disease.
stroke
lINTERACTIONS→Appendix 1 : alteplase
lSIDE-EFFECTS
▶Common or very commonHaemorrhage
▶UncommonCerebral embolism.haemothorax
▶Rare or very rareAgitation.confusion.delirium.
depression.epilepsy.psychosis.speech disorder
▶Frequency not knownBrain oedema (caused by
reperfusion)
lALLERGY AND CROSS-SENSITIVITYContra-indicated if
history of hypersensitivity to gentamicin (residue from
manufacturing process).
lDIRECTIONS FOR ADMINISTRATIONForintravenous infusion
(Actilyse®), dissolve in Water for Injections to a
concentration of 1 mg/mL or 2 mg/mL and infuse
intravenously; alternatively dilute further in Sodium
Chloride 0. 9 % to a concentration of not less than
200 micrograms/mL; not to be diluted in Glucose.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: solution for injection
Powder and solvent for solution for injection
▶Actilyse(Boehringer Ingelheim Ltd)
Alteplase 10 mgActilyse 10 mg powder and solvent for solution for
injection vials| 1 vialP£ 172. 80
Alteplase 20 mgActilyse 20 mg powder and solvent for solution for
injection vials| 1 vialP£ 259. 20
Powder and solvent for solution for infusion
▶Actilyse(Boehringer Ingelheim Ltd)
Alteplase 50 mgActilyse 50 mg powder and solvent for solution for
infusion vials| 1 vialP£ 432. 0088 Blood clots BNFC 2018 – 2019
Cardiovascular system2