Reteplase adverse reactions: Difference between revisions
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===Bleeding=== | ===Bleeding=== | ||
The most frequent adverse reaction associated with Retavase® is bleeding (see WARNINGS). The types of bleeding events associated with thrombolytic therapy may be broadly categorized as either intracranial hemorrhage or other types of hemorrhage. | The most frequent adverse reaction associated with Retavase® is bleeding (see [[Reteplase warnings and precautions|WARNINGS]]). The types of bleeding events associated with [[thrombolytic therapy]] may be broadly categorized as either [[intracranial hemorrhage]] or other types of hemorrhage. | ||
===Intracranial hemorrhage=== | ===Intracranial hemorrhage=== | ||
In the INJECT clinical trial the rate of in-hospital, intracranial hemorrhage among all patients treated with Retavase® was 0.8% (23 of 2,965 patients). As seen with Retavase® and other thrombolytic agents, the risk for intracranial hemorrhage is increased in patients with advanced age or with elevated blood pressure. | In the INJECT clinical trial the rate of in-hospital, [[intracranial hemorrhage]] among all patients treated with Retavase® was 0.8% (23 of 2,965 patients). As seen with Retavase® and other thrombolytic agents, the risk for [[intracranial hemorrhage]] is increased in patients with advanced age or with elevated blood pressure. | ||
===Other types of hemorrhage=== | ===Other types of hemorrhage=== | ||
The incidence of other types of bleeding events in clinical studies of Retavase® varied depending upon the use of arterial catheterization or other invasive procedures and whether the study was performed in Europe or the USA. The overall incidence of any bleeding event in patients treated with Retavase® in clinical studies (n = 3,805) was 21.1%. The rates for bleeding events, regardless of severity, for the 10 + 10 unit Retavase® regimen from controlled clinical studies are summarized in Table 3. | The incidence of other types of bleeding events in clinical studies of Retavase® varied depending upon the use of arterial [[catheterization ]]or other invasive procedures and whether the study was performed in Europe or the USA. The overall incidence of any bleeding event in patients treated with Retavase® in clinical studies (n = 3,805) was 21.1%. The rates for bleeding events, regardless of severity, for the 10 + 10 unit Retavase® regimen from controlled clinical studies are summarized in Table 3. | ||
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|[[File:Retavase hemorrahge rates.JPG| | |[[File:Retavase hemorrahge rates.JPG|900px|thumb]] | ||
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In these studies the severity and sites of bleeding events were comparable for Retavase® and the comparison thrombolytic agents. | In these studies the severity and sites of bleeding events were comparable for Retavase® and the comparison thrombolytic agents. | ||
Should serious bleeding in a critical location (intracranial, gastrointestinal, retroperitoneal, pericardial) occur, any concomitant heparin should be terminated immediately. In addition, the second bolus of Retavase® should not be given if the serious bleeding occurs before it is administered. Death and permanent disability are not uncommonly reported in patients who have experienced stroke (including intracranial bleeding) and other serious bleeding episodes. | Should serious bleeding in a critical location (intracranial, gastrointestinal, retroperitoneal, pericardial) occur, any concomitant [[heparin ]]should be terminated immediately. In addition, the second bolus of Retavase® should not be given if the serious bleeding occurs before it is administered. Death and permanent disability are not uncommonly reported in patients who have experienced [[stroke ]](including intracranial bleeding) and other serious bleeding episodes. | ||
Fibrin which is part of the hemostatic plug formed at needle puncture sites will be lysed during Retavase® therapy. Therefore, Retavase®therapy requires careful attention to potential bleeding sites (e.g., catheter insertion sites, arterial puncture sites). | [[Fibrin ]]which is part of the [[hemostatic ]]plug formed at needle puncture sites will be lysed during Retavase® therapy. Therefore, Retavase®therapy requires careful attention to potential bleeding sites (e.g., catheter insertion sites, arterial puncture sites). | ||
===Allergic Reactions=== | ===Allergic Reactions=== | ||
Among the 2,965 patients receiving Retavase® in the INJECT trial, serious allergic reactions were noted in 3 patients, with one patient experiencing dyspnea and hypotension. No anaphylactoid reactions were observed among the 3,856 patients treated with Retavase® in initial clinical trials. In an ongoing clinical trial two anaphylactoid reactions have been reported among approximately 2,500 patients receiving Retavase®. | Among the 2,965 patients receiving Retavase® in the INJECT trial, serious allergic reactions were noted in 3 patients, with one patient experiencing [[dyspnea ]]and [[hypotension]]. No [[anaphylactoid reactions ]]were observed among the 3,856 patients treated with Retavase® in initial clinical trials. In an ongoing clinical trial two [[anaphylactoid reactions]] have been reported among approximately 2,500 patients receiving Retavase®. | ||
===Other Adverse Reactions=== | ===Other Adverse Reactions=== | ||
Patients administered Retavase® as treatment for myocardial infarction have experienced many events which are frequent sequelae of myocardial infarction and may or may not be attributable to Retavase® therapy. These events include cardiogenic shock, arrhythmias (e.g., sinus bradycardia, accelerated idioventricular rhythm, ventricular premature depolarizations, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation), AV block, pulmonary edema, heart failure, cardiac arrest, recurrent ischemia, reinfarction, myocardial rupture, mitral regurgitation, pericardial effusion, pericarditis, cardiac tamponade, venous thrombosis and embolism, and electromechanical dissociation. These events can be life-threatening and may lead to death. Other adverse events have been reported, including nausea and/or vomiting, hypotension, and fever.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = RETAVASE (RETEPLASE) KIT [EKR THERAPEUTICS, INC.] | url =http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=e9ae6656-977c-4105-8528-bee664aab27a | publisher = | date = | accessdate = }}</ref> | Patients administered Retavase® as treatment for [[myocardial infarction]] have experienced many events which are frequent sequelae of [[myocardial infarction]] and may or may not be attributable to Retavase® therapy. These events include[[ cardiogenic shock]], [[arrhythmias ]](e.g., sinus bradycardia, accelerated idioventricular rhythm, ventricular premature depolarizations, [[supraventricular tachycardia]], [[ventricular tachycardia]], [[ventricular fibrillation]]), [[AV block]], [[pulmonary edema]],[[ heart failure]], [[cardiac arrest]], [[recurrent ischemia]], reinfarction, [[myocardial rupture]], [[mitral regurgitation]], [[pericardial effusion]], [[pericarditis]], [[cardiac tamponade]], [[venous thrombosis]]and [[embolism]], and electromechanical dissociation. These events can be life-threatening and may lead to death. Other adverse events have been reported, including [[nausea ]]and/or [[vomiting]], [[hypotension]], and fever.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = RETAVASE (RETEPLASE) KIT [EKR THERAPEUTICS, INC.] | url =http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=e9ae6656-977c-4105-8528-bee664aab27a | publisher = | date = | accessdate = }}</ref> | ||
==References== | ==References== | ||
Revision as of 15:03, 4 March 2014
| Reteplase |
|---|
| Retavase® FDA Package Insert |
| Indications and Usage |
| Dosage and Administration |
| Contraindications |
| Warnings and Precautions |
| Adverse Reactions |
| Drug Interactions |
| Use in Specific Populations |
| Description |
| Clinical Pharmacology |
| Nonclinical Toxicology |
| How Supplied/Storage and Handling |
| Labels and Packages |
| Clinical Trials on Reteplase |
| ClinicalTrials.gov |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]
ADVERSE REACTIONS
Bleeding
The most frequent adverse reaction associated with Retavase® is bleeding (see WARNINGS). The types of bleeding events associated with thrombolytic therapy may be broadly categorized as either intracranial hemorrhage or other types of hemorrhage.
Intracranial hemorrhage
In the INJECT clinical trial the rate of in-hospital, intracranial hemorrhage among all patients treated with Retavase® was 0.8% (23 of 2,965 patients). As seen with Retavase® and other thrombolytic agents, the risk for intracranial hemorrhage is increased in patients with advanced age or with elevated blood pressure.
Other types of hemorrhage
The incidence of other types of bleeding events in clinical studies of Retavase® varied depending upon the use of arterial catheterization or other invasive procedures and whether the study was performed in Europe or the USA. The overall incidence of any bleeding event in patients treated with Retavase® in clinical studies (n = 3,805) was 21.1%. The rates for bleeding events, regardless of severity, for the 10 + 10 unit Retavase® regimen from controlled clinical studies are summarized in Table 3.
 |
In these studies the severity and sites of bleeding events were comparable for Retavase® and the comparison thrombolytic agents.
Should serious bleeding in a critical location (intracranial, gastrointestinal, retroperitoneal, pericardial) occur, any concomitant heparin should be terminated immediately. In addition, the second bolus of Retavase® should not be given if the serious bleeding occurs before it is administered. Death and permanent disability are not uncommonly reported in patients who have experienced stroke (including intracranial bleeding) and other serious bleeding episodes.
Fibrin which is part of the hemostatic plug formed at needle puncture sites will be lysed during Retavase® therapy. Therefore, Retavase®therapy requires careful attention to potential bleeding sites (e.g., catheter insertion sites, arterial puncture sites).
Allergic Reactions
Among the 2,965 patients receiving Retavase® in the INJECT trial, serious allergic reactions were noted in 3 patients, with one patient experiencing dyspnea and hypotension. No anaphylactoid reactions were observed among the 3,856 patients treated with Retavase® in initial clinical trials. In an ongoing clinical trial two anaphylactoid reactions have been reported among approximately 2,500 patients receiving Retavase®.
Other Adverse Reactions
Patients administered Retavase® as treatment for myocardial infarction have experienced many events which are frequent sequelae of myocardial infarction and may or may not be attributable to Retavase® therapy. These events includecardiogenic shock, arrhythmias (e.g., sinus bradycardia, accelerated idioventricular rhythm, ventricular premature depolarizations, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation), AV block, pulmonary edema,heart failure, cardiac arrest, recurrent ischemia, reinfarction, myocardial rupture, mitral regurgitation, pericardial effusion, pericarditis, cardiac tamponade, venous thrombosisand embolism, and electromechanical dissociation. These events can be life-threatening and may lead to death. Other adverse events have been reported, including nausea and/or vomiting, hypotension, and fever.[1]
References
Adapted from the FDA Package Insert.