Tenecteplase

Tenecteplase is a prescription medication used to treat Acute MI. 

• Tenecteplase is available under the following different brand names: TNK tPA, TNKase 

Adult dosage

Powder for injection

• 50mg

Acute MI

Adult dosage

• Administer ASAP (within 30 minutes) after onset of acute MI
• 30-50 mg IV bolus over 5 sec once (based on weight)
• Weight less than 60 kg: 30 mg
• Weight 60-70 kg: 35 mg
• Weight 70-80 kg: 40 mg
• Weight 80-90 kg: 45 mg
• Weight over 90 kg: 50 mg

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Tenecteplase include:

• bleeding, 
• nausea, 
• vomiting, and
• fever

Serious side effects of Tenecteplase include:

• hives, 
• difficult breathing, 
• swelling in the face or throat, 
• continuous bleeding (surgical incision, IV insertion), 
• easy bruising, 
• unusual bleeding (nosebleeds, bleeding gums, incision, catheter, or needle injection), 
• bloody or tarry stools, 
• coughing up blood, 
• vomit that looks like coffee grounds, 
• red or pink urine, 
• sudden numbness or weakness (especially on one side of the body), 
• sudden severe headache, 
• slurred speech, 
• problems with vision or balance, 
• swelling, 
• rapid weight gain, 
• little or no urine, 
• darkening or purple discoloration of the fingers or toes, 
• very slow heartbeats, 
• shortness of breath, 
• lightheadedness, 
• sudden severe back pain, 
• muscle weakness, 
• numbness or loss of feeling in the arms or legs, 
• blurred vision, 
• pounding in the neck or ears, 
• anxiety, 
• nosebleeds, 
• severe pain in the upper stomach spreading to the back, 
• nausea, and 
• vomiting

Rare side effects of Tenecteplase include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Tenecteplase has severe interactions with the following drugs:
  • defibrotide
  • prothrombin complex concentrate, human
• Tenecteplase has serious interactions with the following drugs:
  • apixaban
  • reteplase
  • warfarin
  • zanubrutinib
• Tenecteplase has moderate interactions with at least 77 other drugs.
• Tenecteplase has minor interactions with the following drug:
  • ceftaroline 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity
• Active bleeding, history of CVA, recent (within 2 months) intracranial or intraspinal surgery or trauma, intracranial neoplasm, AVM, aneurysm, bleeding diathesis, severe uncontrolled HTN, recent (within 3 months) facial trauma, suspected aortic dissection. 
• See thrombolytic indications/contraindications.

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Tenecteplase?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Tenecteplase?”

Cautions

• Use caution in patients with recent major surgery, cerebrovascular disease, recent GI or GU bleeding, HTN, acute pericarditis, subacute endocarditis, hemostatic defects, high likelihood of left heart thrombus (such as patients with mitral stenosis or atrial fibrillation), severe thrombophlebitis, severe hepatic/renal dysfunction, currently receiving oral anticoagulants, diabetic hemorrhagic retinopathy, elderly, recent admin of GP IIb/IIIa inhibitors
• Acute pericarditis, subacute endocarditis
• Ischemic Stroke: may have no benefit if used after 3 hours of onset
• Current use of warfarin and INR in high range may increase bleeding risk; concomitant heparin or antiplatelet agents should be discontinued immediately and treated appropriately
• Monitor potential bleeding sites
• Cholesterol embolism reported

Pregnancy or breastfeeding

• Adjuncts for MI treatment
• Hypersensitivity, including urticarial / anaphylactic reactions, reported after administration (e.g., anaphylaxis, angioedema, laryngeal edema, rash, and urticaria); monitor patients treated with TNKase during and for several hours after infusion; if symptoms of hypersensitivity occur, initiate appropriate therapy

Pregnancy and Lactation

• Drug has been shown to elicit maternal and embryo toxicity in rabbits given multiple IV administrations; subsequent embryonic deaths were secondary to maternal hemorrhage and no fetal anomalies were observed. 
• Not known whether drug crosses into breast milk, nursing not a priority in AMI