Presentation
- 50 mg in glass vial with weight marked and pre-filled syringe containing water for IV administration (must reconstitute all drug then discard unwanted amount according to weight)
Pharmacology
Fibrinolytic, a modified form of tissue plasminogen activator (tPA) that binds to
fibrin and converts plasminogen to plasmin
Metabolism
Metabolised by the liver
- Acute STEMI
- Major surgery in the past 3 months
- Significant head injury in the past 3 months
- Major trauma in the past 3 months
- Stroke/TIA in the past 3 months
- ICH at any time
- GI or genitourinary bleed in the past month
- Current bleeding disorder, active bleeding (excluding menses) or bleeding tendencies
- Anticoagulants or glycoprotein IIb/IIIa inhibitors
- Allergy to tenecteplase or gentamicin
- Age ≥ 75 years
- Non-compressible vascular puncture
- History of liver disease
- SBP > 160 mmHg or DBP > 110 mmHg
- Low body weight
- Active peptic ulcer
- Anaemia
- Acute pericarditis or subacute bacterial endocarditis
- Traumatic or prolonged (>10 mins) CPR
- Pregnant or within 1 week post-partum
- HR > 120 bpm
Route of administration
- IV, using vial adapter on pre-prepared syringe, as single bolus over 10 seconds;
- IO (consult)
- Bleeding – including injection sites, ICH, internal bleeding
- Transient hypotension
- Allergic reactions including fever, chills, rash, nausea, headache, bronchospasm, vasculitis, nephritis and anaphylaxis
- Cholesterol embolism
Special Notes
Weight optimised dosing improves efficacy and safety outcomes in drugs with
narrow therapeutic index e.g. Fibrinolytics
Other drugs which affect the clotting process may increase risk of bleeding
associated with Tenecteplase.