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TNKase
tenecteplase
Adult Dosing .
Dosage forms: INJ
STEMI
- [<60 kg]
- Dose: 30 mg IV x1; Start: ASAP from symptom onset
- [60-69 kg]
- Dose: 35 mg IV x1; Start: ASAP from symptom onset
- [70-79 kg]
- Dose: 40 mg IV x1; Start: ASAP from symptom onset
- [80-89 kg]
- Dose: 45 mg IV x1; Start: ASAP from symptom onset
- [>90 kg]
- Dose: 50 mg IV x1; Start: ASAP from symptom onset
acute ischemic stroke
- [<60 kg]
- Dose: 15 mg IV x1; Start: ASAP within 3h of symptom onset
- [60-69 kg]
- Dose: 17.5 mg IV x1; Start: ASAP within 3h of symptom onset
- [70-79 kg]
- Dose: 20 mg IV x1; Start: ASAP within 3h of symptom onset
- [80-89 kg]
- Dose: 22.5 mg IV x1; Start: ASAP within 3h of symptom onset
- [>90 kg]
- Dose: 25 mg IV x1; Start: ASAP within 3h of symptom onset
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- mild-moderate impairment: not defined; severe impairment: not defined, caution advised
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- HTN, severe uncontrolled
- coagulation disorder
- internal bleeding, active
- intracranial aneurysm
- intracranial AVM
- intracranial neoplasm
- intracranial surgery within prior 2mo
- intracranial trauma within prior 2mo
- intraspinal surgery within prior 2mo
- intraspinal trauma within prior 2mo
- ischemic stroke within prior 3mo (STEMI use)
- intracranial hemorrhage history (STEMI use)
- intracranial hemorrhage, active (stroke use)
- caution: surgery, recent major
- caution: trauma, recent
- caution: PCI, concurrent
- caution: cerebrovascular disease
- caution: GI bleeding, recent
- caution: GU bleeding, recent
- caution: HTN
- caution: pericarditis, acute
- caution: SBE
- caution: LV thrombus, known or suspected
- caution: hemostatic disorder
- caution: ophthalmic condition, hemorrhagic
- caution: thrombophlebitis, septic
- caution: occluded AV cannula at serious infection site
- caution: hepatic impairment, severe
- caution: elderly patients
Drug Interactions .
Overview
tenecteplase
thrombolytic
- anticoagulant
Contraindicated
- defibrotide
- mifepristone
Avoid/Use Alternative
- anagrelide
- caplacizumab
- collagenase clostridium histolyticum
- danshen
- edoxaban
- enoxaparin
- fondaparinux
- ibritumomab tiuxetan
- lifileucel
- remibrutinib
- rivaroxaban
- vorapaxar
Monitor/Modify Tx
- acalabrutinib
- ado-trastuzumab emtansine
- afatinib
- alpha-tocopherol (vitamin E)
- alprostadil intracavernous
- alprostadil intravenous
- anacaulase topical
- antithrombin
- apixaban
- argatroban
- asparaginase
- aspirin
- avapritinib
- axitinib
- bevacizumab
- binimetinib
- bivalirudin
- brentuximab vedotin
- bromelain
- bromfenac ophthalmic
- cabazitaxel
- cabozantinib
- calaspargase
- cangrelor
- cannabis
- carfilzomib
- cefaclor
- cefadroxil
- cefazolin
- cefdinir
- cefepime
- cefixime
- cefotetan
- cefoxitin
- cefpodoxime
- cefprozil
- ceftazidime
- ceftriaxone
- cefuroxime axetil
- cefuroxime sodium
- celecoxib
- cephalexin
- cilostazol
- citalopram
- clopidogrel
- cysteamine
- dabigatran
- dalteparin
- dasatinib
- deferasirox
- desvenlafaxine
- deuruxolitinib
- diclofenac
- diclofenac ophthalmic
- diclofenac topical
- diflunisal
- dimethyl fumarate
- diosmin
- dipyridamole
- diroximel fumarate
- donanemab
- duloxetine
- encorafenib
- epoprostenol
- eptifibatide
- erlotinib
- escitalopram
- ethanol (alcoholic beverage)
- etodolac
- evening primrose oil
- fenoprofen
- fenugreek
- fluoxetine
- flurbiprofen
- flurbiprofen ophthalmic
- fluvoxamine
- fruquintinib
- garlic
- gefitinib
- gemtuzumab ozogamicin
- ginkgo
- heparin
- hydrocortisone
- ibrutinib
- ibuprofen
- ibuprofen lysine
- icosapent ethyl
- imatinib
- indomethacin
- ketoprofen
- ketorolac
- ketorolac ophthalmic
- lecanemab
- lenvatinib
- levomilnacipran
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- methotrexate
- methyl salicylate topical
- methyltestosterone
- milnacipran
- mitotane
- monomethyl fumarate
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- naproxen
- nattokinase
- nepafenac ophthalmic
- niacin (vitamin B3)
- nilotinib
- nintedanib
- nusinersen
- obinutuzumab
- omega-3-acid
- oxaliplatin
- oxaprozin
- pacritinib
- paroxetine
- pazopanib
- pegaspargase
- penicillin G
- pentosan polysulfate sodium
- pentoxifylline
- piperacillin
- piroxicam
- pirtobrutinib
- plasminogen, human
- ponatinib
- porfimer
- pralsetinib
- prasugrel
- ramucirumab
- ranibizumab
- regorafenib
- resveratrol
- revakinagene taroretcel
- rifampin
- salsalate
- saw palmetto
- selpercatinib
- selumetinib
- sepiapterin
- sertraline
- sirolimus albumin-bound
- sorafenib
- sotatercept
- sugammadex
- sulindac
- sunitinib
- temsirolimus
- testosterone
- ticagrelor
- tipranavir
- tirofiban
- tisotumab vedotin
- tivozanib
- tolmetin
- tovorafenib
- trametinib
- trazodone
- treprostinil
- upadacitinib
- vadadustat
- valproic acid
- vandetanib
- venlafaxine
- vilazodone
- vinpocetine
- vortioxetine
- warfarin
- willow bark
- zanubrutinib
- ziv-aflibercept
Caution Advised
- aminocaproic acid
- tranexamic acid
Adverse Reactions .
Serious Reactions
- intracranial hemorrhage
- bleeding, severe
- arrhythmia, reperfusion
- anaphylaxis
- angioedema
- cholesterol embolism
- hypersensitivity reaction
Common Reactions
- bleeding
Safety/Monitoring .
Monitoring Parameters
STEMI: PT/INR, aPTT, BP at baseline, then periodically; signs/symptoms of hypersensitivity reaction during infusion and for at least 2h after D/C
Stroke: PT/INR, aPTT at baseline, then periodically; BP at baseline, then q15min x2h, then q30min x6h, then q1h x16h; signs/symptoms of hypersensitivity reaction during infusion and for at least 2h after D/C
Look/Sound-Alike Drug Names
TNKase confused with: Activase; alteplase; t-PA (synonym for alteplase)
Pregnancy/Lactation .
Pregnancy
Clinical Summary
benefits outweigh risks during pregnancy; no human data available; no known risk of fetal harm based on animal data at 8-10x recommended human dose, though risk of vaginal hemorrhage and death in pregnant patients based on animal data at up to 5 mg/kg/day; risk of hemorrhage in pregnant patients during delivery based on drug's mechanism of action
Lactation
Clinical Summary
may use while breastfeeding; no human data available, though risk of infant harm or adverse effects on milk production not expected based on drug properties
Pharmacology .
Metabolism: for tenecteplase: liver; CYP450: unknown
Excretion: for tenecteplase: other; Half-life: 90-130min
Subclass: Thrombolytics, Recombinant Tissue Plasminogen Activators (rtPA)
Mechanism of Action
for tenecteplase: binds to fibrin and converts tissue plasminogen to plasmin, promoting fibrinolysis
Formulary .
No Formulary Selected
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