Formulary
Tenecteplase: Indications, Dosing, Side Effects and Interactions
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
MedNext Academy | 3 min read
Tenecteplase: Indications, Dosing, Side Effects and Interactions
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
Drug action
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
Indications and dose
**Acute myocardial infarction [using 50 mg (10 000 unit) vial] (under expert supervision)**
- **Adult** (By Intravenous Injection): (body-weight 90 kg and above) 50 mg for 1 dose, to be given over 10 seconds, treatment should begin as soon as possible within 6 hours of symptom onset.
**Acute ischaemic stroke [using 25 mg (5000 unit) vial] (under expert supervision)**
- **Adult** (By Intravenous Injection): (body-weight 90 kg and above) 25 mg for 1 dose, to be given over 5-10 seconds, treatment should begin as soon as possible within 4.5 hours of symptom onset and when intracranial haemorrhage excluded by imaging.
Cautions
Conditions in which thrombolysis might give rise to embolic complications such as enlarged left atrium with atrial fibrillation (risk of dissolution of clot and subsequent embolisation); elderly; external chest compression; hypertension; risk of bleeding (including that from venepuncture or invasive procedures) Cautions For tenecteplase When used for Acute ischaemic stroke Severe stroke (National Institutes of Health Stroke Scale (NIHSS) > 25 and/or as assessed by imaging)
Contraindications
Acute pancreatitis; aneurysm; aortic dissection; arteriovenous malformation; bacterial endocarditis; bleeding diatheses; coagulation defects; coma; heavy vaginal bleeding; history of cerebrovascular disease (especially recent events or with any residual disability); neoplasm with risk of haemorrhage; oesophageal varices; pericarditis; recent gastro-intestinal ulceration; recent haemorrhage; recent surgery (including dental extraction); recent trauma; severe hypertension Contra-indications For tenecteplase When used for Acute ischaemic stroke Acute ischaemic stroke without disabling neurological deficit or symptoms rapidly improving before start of injection; history of stroke and concomitant diabetes; hyperglycaemia; hypoglycaemia; platelet count less than 100,000 mm 3 ; seizure accompanying stroke; stroke in last 3 months; symptoms suggestive of subarachnoid haemorrhage When used for Acute myocardial infarction Dementia
Side effects
Common or very common Anaphylactic reaction; angina pectoris; cardiac arrest; cardiogenic shock; chills; CNS haemorrhage; ecchymosis; fever; haemorrhage; heart failure; ischaemia recurrent (when used in myocardial infarction); nausea; pulmonary oedema; vomiting Uncommon Mitral valve incompetence; reperfusion arrhythmia (when used in myocardial infarction) Rare or very rare Seizure Side-effects, further information Serious bleeding calls for discontinuation of the thrombolytic and may require administration of coagulation factors and antifibrinolytic drugs. Side-effects For tenecteplase Frequency not known Fat embolism
Interactions
**Other interactions (3):**
- No formal interaction studies with tenecteplase and medicinal products commonly administered in patients with AMI have been performed.
- However, the analysis of data from more than 12 000 patients treated during phase I, II and III did not reveal any clinically relevant interactions with medicinal products commonly used in patients...
- Drugs affecting coagulation/platelet function Medicinal products that affect coagulation or those that alter platelet function (e.g.
Pregnancy
Thrombolytic drugs can possibly lead to premature separation of the placenta in the first 18 weeks of pregnancy. There is also a risk of maternal haemorrhage throughout pregnancy and post-partum, and also a theoretical risk of fetal haemorrhage throughout pregnancy.
Breast feeding
Manufacturer advises avoid breast-feeding for 24 hours after dose (express and discard milk during this time).
Hepatic impairment
Manufacturers advise avoid in severe impairment.
Medicinal forms
Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Tenecteplase in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary

