netFormulary The Pennine Acute Hospitals NHS
NHS Trust Formulary  
 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.10.02  Expand sub section  Fibrinolytic drugs
Alteplase (Actilyse®)
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Actilyse Injection

Restricted ItemActilyse Cathflo 2mg (for thrombolytic treatment of occluded central venous access devices)is restricted to  NMGH Renal Unit only;

Approved for pulmonary embolism, acute ischaemic stroke (FGH only) and thrombolysis in acute limb ischaemia.

Alteplase is recommended for the treatment of acute ischaemic stroke in adults in accordance with its licensed indication if:
  • treatment is started as early as possible within 4.5 hoursof onset of stroke symptoms, AND
  • intracranial haemorrhage has been excluded by appropriate imaging techniques
  • See NICE TA264
    Link  Adult Loading Doses Policy
    Link  NICE TA264: Ischaemic stroke (acute) - alteplase
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    Formulary Injection 
    Tenecteplase (Metalyse®)
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    Formulary Injection 
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    Formulary Injection 
     Non Formulary Items
    Reteplase  (Rapilysin®)

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    Non Formulary
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    Restricted Drug
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    Unlicensed Drug
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    NHS England

    Traffic Light Status Information

    Status Description


    Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   


    These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  


    Not used   

    Green 1

    Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

    Green 2

    Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

    Green 3

    Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  


    Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   


    Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.