tenecteplase

Contraindicated in:

Active internal bleeding;
History of cerebrovascular accident;
Recent (within 2 mo) intracranial or intraspinal surgery or trauma;
Intracranial neoplasm, arteriovenous malformation, or aneurysm;
Severe uncontrolled hypertension;
Known bleeding diathesis;
Hypersensitivity.

Use Cautiously in:

Recent major surgery, trauma, GI, or GU bleeding;
Cerebrovacular disease;
Hypertension (BP ≥180 mm Hg and or diastolic ≥110 mm Hg);
Presence or high likelihood of left heart thrombus;
Subacute bacterial endocarditis or acute pericarditis;
Hemostatic defect especially those associated with severe hepatic or renal disease;
Severe hepatic impairment;
Hemorrhagic ophthalmic conditions;
Septic phlebitis or occluded AV cannula at infected site;
Concurrent warfarin therapy or recent therapy with glycoprotein IIb/IIIa inhibitors (eptifibatide, tirofiban);
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may have ↑ risk of intracranial bleeding.

Adv. Reactions/Side Effects ⬆ ⬇

Adverse reactions are frequently sequelae of underlying disease

CV: cardiac tamponade, ARRHYTHMIAS, CARDIOGENIC SHOCK, HF, hypotension, MI, MYOCARDIAL RUPTURE, PERICARDITIS, PERICARDIAL EFFUSION, RECURRENT MYOCARDIAL ISCHEMIA, THROMBOEMBOLISM

GI: nausea, vomiting

Hemat: BLEEDING

Resp: PULMONARY EDEMA

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), fever

Interactions ⬆ ⬇

Drug-drug:

Aspirin, NSAIDs, warfarin, heparin and heparin-like agents, eptifibatide, tirofiban, clopidogrel, or dipyridamole—concurrent use may ↑ the risk of bleeding, although these agents are frequently used together or in sequence.
Risk of bleeding may be ↑ by concurrent use of cefotetanor valproic acid.

Availability ⬆ ⬇

Powder for injection: 50 mg/vial

Route/Dosage ⬆ ⬇

IV (Adults ≥90 kg): 50 mg as a single dose.
IV (Adults ≥80 kg and <90 kg): 45 mg as a single dose.
IV (Adults ≥70 kg and <80 kg): 40 mg as a single dose.
IV (Adults ≥60 kg and <70 kg): 35 mg as a single dose.
IV (Adults <60 kg): 30 mg as a single dose.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Converts plasminogen to plasmin, which is then able to degrade fibrin present in clots. Directly activates plasminogen.

Therapeutic effects:

Lysis of thrombi in coronary arteries, with resultant decrease in mortality.

Classifications ⬆ ⬇

Therapeutic Classification: thrombolytics

Pharmacologic Classification: plasminogen activators

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Mostly metabolized by the liver.

Half-Life: Initial phase: 20–24 min; terminal phase: 90–130 min.

Time/Action Profile ⬆ ⬇

(fibrinolysis)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Explain to patient and family the purpose of tenecteplase and the need for close monitoring.
Advise patient to remain on bedrest and to avoid unnecessary procedures such as shaving and vigorous toothbrushing for 24 hr.
Instruct patient to report signs of hypersensitivity and bleeding promptly.

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Indications ⬇

Contraind./Precautions ⬆ ⬇