Usual Adult Dose for Myocardial Infarction

less than 60 kg: 30 mg IV bolus administered over 5 seconds.
60 to less than 70 kg: 35 mg IV bolus administered over 5 seconds
70 to less than 80 kg: 40 mg IV bolus administered over 5 seconds
80 to less than 90 kg: 45 mg IV bolus administered over 5 seconds
90 kg or greater: 50 mg IV bolus administered over 5 seconds

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Tenecteplase is contraindicated in the following clinical situations due to an increased risk of bleeding: (1) active internal bleeding, (2) history of cerebrovascular accident, (3) intracranial or intraspinal surgery or trauma within 2 months, (4) intracranial neoplasm, arteriovenous malformation, or aneurysm, (5) known bleeding diathesis, (6) severe uncontrolled hypertension.

In general, tenecteplase should be used cautiously if at all in clinical situations associated with an increased risk of bleeding (i.e., major surgery, recent history of bleeding or trauma).

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

Reperfusion arrhythmias during therapy with tenecteplase can be a sign of successful coronary thrombolysis. These arrhythmias (e.g., sinus bradycardia, accelerated idioventricular rhythm, ventricular premature repolarizations, ventricular tachycardia) may also be seen during the natural course of acute myocardial infarction, and should be treated with appropriate antiarrhythmic measures. It is recommended that standard antiarrhythmia therapy for bradycardia and/or ventricular irritability be available during tenecteplase therapy.

Precipitation may occur when tenecteplase is administered in an IV line containing dextrose. Flush dextrose-containing lines with a saline-containing solution prior to and following single bolus administration of tenecteplase.

If serious bleeding (not controlled by local pressure) occurs, immediately discontinue any concomitant heparin or antiplatelet agents.

Avoid intramuscular injections and nonessential handling of the patient for the first few hours following treatment with tenecteplase. Perform and monitor venipunctures carefully.

For the treatment of acute myocardial infarction, it is recommended that tenecteplase therapy should be started as soon as possible within 12 hours after the onset of symptoms.

Although tenecteplase appears promising, it has not been extensively studied in the treatment of ischemic stroke. According to AHA/ASA guidelines for the early management of ischemic stroke, use of a thrombolytic agent (i.e., recombinant tissue plasminogen activator; alteplase) within 3 hours of stroke symptom onset is associated with improved outcomes. Earlier treatment (i.e., within 90 minutes) may be more likely to result in a favorable outcome. However, the upper limit of the treatment window may be as late as 5 to 6 hours after symptom onset.

Frequently asked questions

• Is Activase the same as tPA?