Confirmation
Open All
Tenecteplase
Tenecteplase
Classification
High alert medication
Thrombolytic agent
Indications
ACP with endorsement and training: Coronary reperfusion in ST elevation myocardial infarction
CCP: Coronary reperfusion in ST elevation myocardial infarction
Contraindications
Patient must meet criteria for entry into CHAMP pathway
- Active internal bleeding
- History of cerebrovascular accident
- Intracranial or intraspinal surgery, or trauma within 2 months
- Intracranial neoplasm, ateriovenous malformation, or aneurysm
- Known bleeding diathesis
- Severe uncontrolled hypertension
- Known hypersensitivity to tenecteplase or any components of the formulation
Adult dosages
Follow weight and age-based dosing
For intravenous administration only. Push over 5 seconds.
Pediatric Considerations And Dosing
Not authorized in pediatrics
How Supplied
Lyophilized powder in a 50 mg glass vial, with 10 mL vial of sterile water for reconstitution. Follow instructions for reconstitution of tenecteplase.
- Remove the shield assembly from the supplied 10 cc syringe with the TwinPak Dual Cannula device and aseptically withdraw 10 mL of sterile water for injection (SWFI) from the supplied diluent vial using the red hub cannula syringe filling device. Do not use bacteriostatic water for injection. Note: do not discard the shield assembly.
- Inject the entire contents of the syringe (10 mL) into the vial of tenecteplase, directing the diluent stream into the powder. Slight foaming upon reconstitution is not unusual; any large bubbles will dissipate if the product is allowed to stand undisturbed for several minutes.
- Gently swirl until the contents are completely dissolved. Do not shake. The reconstituted preparation is a colourless to pale yellow transparent solution containing tenecteplase at 5 mg/mL at a pH of approximately 7.3. The osmolality of this solution is approximately 290 mOsm/kg.
- Determine the appropriate dose of tenecteplase (see the dose information table) and withdraw this volume (in millilitres) from the reconstituted vial with the syringe. Any unused solution should be discarded.
- Once the appropriate dose of tenecteplase has been drawn into the syringe, stand the shield vertically on a flat surface, with the green side down, and passively recap the red hub cannula.
- Remove the entire shield assembly, including the red hub cannula, by twisting counter-clockwise. Note: the shield assembly also contains the clear-ended blunt plastic cannula; retain this for split septum IV access.
Mechanism Of Action
Tenecteplase is a modified form of human tissue plasminogen activator (tPA) binding to fibrin and converting plasminogen to plasmin.
Pharmacokinetics
Following a single bolus dose of tenecteplase:
- Plasma half-life: 20-24 minutes
- Distribution: plasma
- Metabolism: liver
Adverse Effects
The most frequent adverse reaction associated with tenecteplase is bleeding.
Overdose
Overdose is considered unlikely.
Warning And Precautions
- Coronary reperfusion may result in reperfusion arrhythmias.
- Internal and external bleeding may occur. Monitor all potential bleeding sites. Minimize venous and arterial punctures.
Drug Interactions
- Antiplatelet agents may enhance the anticoagulant effect of thrombolytic agents and may in turn have their antiplatelet effects enhanced by thrombolytic agents.
- Tranexamic acid may diminish the therapeutic effect of thrombolytic agents.
Classification
High alert medication
Thrombolytic agent
Indications
ACP with endorsement and training: Coronary reperfusion in ST elevation myocardial infarction
CCP: Coronary reperfusion in ST elevation myocardial infarction
Contraindications
Patient must meet criteria for entry into CHAMP pathway
- Active internal bleeding
- History of cerebrovascular accident
- Intracranial or intraspinal surgery, or trauma within 2 months
- Intracranial neoplasm, ateriovenous malformation, or aneurysm
- Known bleeding diathesis
- Severe uncontrolled hypertension
- Known hypersensitivity to tenecteplase or any components of the formulation
Adult dosages
Follow weight and age-based dosing
For intravenous administration only. Push over 5 seconds.
Pediatric Considerations And Dosing
Not authorized in pediatrics
How Supplied
Lyophilized powder in a 50 mg glass vial, with 10 mL vial of sterile water for reconstitution. Follow instructions for reconstitution of tenecteplase.
- Remove the shield assembly from the supplied 10 cc syringe with the TwinPak Dual Cannula device and aseptically withdraw 10 mL of sterile water for injection (SWFI) from the supplied diluent vial using the red hub cannula syringe filling device. Do not use bacteriostatic water for injection. Note: do not discard the shield assembly.
- Inject the entire contents of the syringe (10 mL) into the vial of tenecteplase, directing the diluent stream into the powder. Slight foaming upon reconstitution is not unusual; any large bubbles will dissipate if the product is allowed to stand undisturbed for several minutes.
- Gently swirl until the contents are completely dissolved. Do not shake. The reconstituted preparation is a colourless to pale yellow transparent solution containing tenecteplase at 5 mg/mL at a pH of approximately 7.3. The osmolality of this solution is approximately 290 mOsm/kg.
- Determine the appropriate dose of tenecteplase (see the dose information table) and withdraw this volume (in millilitres) from the reconstituted vial with the syringe. Any unused solution should be discarded.
- Once the appropriate dose of tenecteplase has been drawn into the syringe, stand the shield vertically on a flat surface, with the green side down, and passively recap the red hub cannula.
- Remove the entire shield assembly, including the red hub cannula, by twisting counter-clockwise. Note: the shield assembly also contains the clear-ended blunt plastic cannula; retain this for split septum IV access.
Mechanism Of Action
Tenecteplase is a modified form of human tissue plasminogen activator (tPA) binding to fibrin and converting plasminogen to plasmin.
Pharmacokinetics
Following a single bolus dose of tenecteplase:
- Plasma half-life: 20-24 minutes
- Distribution: plasma
- Metabolism: liver
Adverse Effects
The most frequent adverse reaction associated with tenecteplase is bleeding.
Overdose
Overdose is considered unlikely.
Warning And Precautions
- Coronary reperfusion may result in reperfusion arrhythmias.
- Internal and external bleeding may occur. Monitor all potential bleeding sites. Minimize venous and arterial punctures.
Drug Interactions
- Antiplatelet agents may enhance the anticoagulant effect of thrombolytic agents and may in turn have their antiplatelet effects enhanced by thrombolytic agents.
- Tranexamic acid may diminish the therapeutic effect of thrombolytic agents.