• Reduction of mortality associated with acute myocardial infarction.

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 dysfunction
• Geriatric patients (increased risk of intracranial bleeding)
• Hemorrhagic ophthalmic conditions
• Septic phlebitis or occulded AV cannula at infected site
• Concurrent warfarin therapy or recent therapy with glycoptrotein (GP) IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban)
• Pregnancy, lactation, or children (safety not established).

Adverse reactions are frequently sequelae of underlying disease

CV: ARRHYTHMIAS, CARDIOGENIC SHOCK, cardiac tamponade, EMBOLISM, HEART FAILURE, MYOCARDIAL INFARCTION, MYOCARDIAL RUPTURE, PERICARDITIS, PERICARDIAL EFFUSION, PULMONARY EDEMA, RECURRENT MYOCARDIAL ISCHEMIA, THROMBOSIS, hypotension.

GI: nausea, vomiting.

Hemat: BLEEDING.

Misc: allergic reactions including anaphylaxis, fever.

Drug-Drug:

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

• Powder for injection: 50 mg/vial with 10 mL syringe and TwinPak Dual Cannula Device, and 10 mL vial of sterile water for injection;

• IV (Adults <60 kg): 30 mg.
• IV (Adults 60 kg and <70 kg): 35 mg.
• IV (Adults 70 kg and <80 kg): 40 mg.
• IV (Adults 80 kg and <90 kg): 45 mg.
• IV (Adults 90 kg): 50 mg.

TNKase

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

• Lysis of thrombi in coronary arteries, with preservation of myocardium and resultant decrease in mortality.

Therapeutic Classification: thrombolytics

Pharmacologic Classification: plasminogen activators

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.

(fibrinolysis)

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

te-NEK-te-plase

NDC Code^*

• 50242- Genentech, Inc.
  • 50242-120- TNKase
    • 50242-120-01- 1 KIT in 1 CARTON (50242-120-01) * 10 mL in 1 VIAL, SINGLE-USE * 1 mL in 1 PACKET * 50 mg in 1 VIAL, SINGLE-USE

• 50242- Genentech, Inc.
  • 50242-120- TNKase
    • 50242-120-47- 1 KIT in 1 CARTON (50242-120-47) * 1 VIAL, SINGLE-USE in 1 CARTON (50242-037-06) > 50 mg in 1 VIAL, SINGLE-USE * 1 VIAL, SINGLE-USE in 1 CARTON (50242-901-09) > 10 mL in 1 VIAL, SINGLE-USE