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# Reteplase

A shortened recombinant tissue plasminogen activator with a longer half-life, given as two boluses in acute myocardial infarction.

Updated 2026-11-01

- Class: [Thrombolytics (fibrinolytics)](https://durgical.com/en/pharmacology/classes/thrombolytics/)
- Enzyme: Plasminogen (the zymogen of plasmin), bound to fibrin
- ATC code: B01AD07

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

✂**Plasminogen (the zymogen of plasmin), bound to fibrin**Reteplase

ⓘ The figure shows full-length human plasminogen, the substrate that reteplase cuts into plasmin; the drug itself is not in the crystal.

**Target in 3D:** Plasminogen (the zymogen of plasmin), bound to fibrin. PDB structure 4DUR (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/4DUR) · Drag to rotate · pinch to zoom

## Mechanism of action

Reteplase is a recombinant tissue plasminogen activator from which several amino-acid sequences have been deleted. It keeps the protease domain, so it converts plasminogen into plasmin and dissolves the clot, but it is cleared more slowly than alteplase.

- The drug binds fibrin inside the clot
- It cuts fibrin-bound plasminogen into plasmin
- Plasmin breaks fibrin into degradation products
- The artery reopens; blood flow returns

## Pharmacokinetics

**Half-life**
Longer than alteplase, which allows bolus dosing

## Indications

- Acute ST-elevation myocardial infarction [Myocardial Infarction (Heart Attack) →](https://durgical.com/en/conditions/myocardial-infarction/)

## Adverse effects

### Common

- Bleeding
- Bruising at puncture sites

### Serious (rare, important)

- Intracranial haemorrhage
- Allergic reactions

## Contraindications

- Previous intracranial haemorrhage, or a known cerebral vascular lesion or brain tumour
- Active bleeding or a bleeding disorder
- Suspected aortic dissection
- Recent ischaemic stroke, significant head trauma or brain or spinal surgery
- Severe uncontrolled hypertension

## Key interactions

**Heparin, anticoagulants and antiplatelets (aspirin, clopidogrel)**
Add to the bleeding risk; serious haemorrhage is more frequent when heparin is given at the same time

**Warfarin (raised INR)**
Current warfarin use with a raised INR is a relative contraindication

## What is monitored

- Neurological status and blood pressure
- Signs of bleeding; haemoglobin and coagulation tests
- Reperfusion: ECG and symptoms in myocardial infarction

## Administration and safety

- Two intravenous boluses separated in time; record the time of each
- Not to be confused with alteplase or tenecteplase: different doses and schedules

## Nursing care

- Check the time symptoms began and go through the contraindication checklist before the drug is mixed
- Neurological checks and blood pressure often during and after the infusion; a sudden headache, vomiting or a drop in consciousness suggests intracranial bleeding
- Look for bleeding at puncture sites, gums, urine and stool
- Avoid new arterial punctures, intramuscular injections and unnecessary venepunctures

## Pregnancy and breastfeeding

There are few data in pregnancy; it is used only when the maternal benefit outweighs the bleeding risk.

## Memory aid

REteplase = REpeat: two boluses.

## Test yourself

Think of the answer, then tap the question to see it.

## How is reteplase different structurally from alteplase?

Several amino-acid sequences are deleted; the protease domain remains.

## What is its main indication?

Acute ST-elevation myocardial infarction.

## Why can it be given as boluses?

Its half-life is longer than that of alteplase.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/reteplase/)

## Related drugs

- [Alteplase](https://durgical.com/en/pharmacology/alteplase/)
- [Tenecteplase](https://durgical.com/en/pharmacology/tenecteplase/)

## Related conditions

- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)

[← Back to the class: Thrombolytics (fibrinolytics)](https://durgical.com/en/pharmacology/classes/thrombolytics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Reteplase Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a625038.html) (MedlinePlus (U.S. National Library of Medicine), 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 36 (McGraw Hill, 2023); Farmacología básica y clínica (Katzung), 16.ª ed., cap. 34 (McGraw Hill, 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=B01AD07) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/reteplase/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/reteplase/