Tenecteplase

Indications

Tenecteplase is used for: Acute myocardial infarction

Adult Dose

Intravenous Acute myocardial infarction Adult: 30-50 mg as a single bolus dose over 5-10 sec as soon as possible after the onset of symptoms. The dose is based on body weight. Max: 50mg. Administer ASAP (within 30 minutes) after onset of acute MI 30-50 mg IV bolus over 5 sec once (based on weight) <60 kg: 30 mg 60-70 kg: 35 mg 70-80 kg: 40 mg 80-90 kg: 45 mg >90 kg: 50 mg

Child Dose

Renal Dose

Administration

IV Preparation Add 10 mL SWI to a 50 mg vial using TwinPak® device directing stream of diluent into powder. If foaming (usually slight) occurs, leave vial undisturbed for several minutes to allow dissipation of any large bubbles. Gently swirl (do not shake) until contents are completely dissolved.

Contra Indications

Patients at risk of cerebral bleeding including severe hypertension, history of stroke, intracranial or intraspinal surgery or trauma within 2 mth, arteriovenous malformation or aneurysm, cerebral neoplasm. Haemorrhage or known bleeding diathesis.

Precautions

Patients with increased risk of bleeding. Recent history of GI or genitourinary bleed, recent major surgery, previous puncture of noncompressible vessels, hypertension (>180/110 mm Hg), high risk of left heart thrombus, acute pericarditis, subacute bacterial endocarditis, coagulation defects, invasive procedures, haemorrhagic ophthalmic conditions. Elderly, pregnancy and lactation. Severe hepatic impairment. Lactation: not known whether drug crosses into breast milk, nursing not a priority in AMI

Pregnancy-Lactation

Pregnancy Drug has been shown to elicit maternal and embryo toxicity in rabbits given multiple IV administrations; subsequent embryonic deaths were secondary to maternal hemorrhage and no fetal anomalies were observed Lactation Not known whether drug crosses into breast milk, nursing not a priority in AMI

Interactions

Increased risk of haemorrhage with heparin, oral anticoagulants, antiplatelet drugs and other drugs that can affect platelet function.

Adverse Effects

Side effects of Tenecteplase : >10% Minor bleeding (22%) Frequency Not Defined Reperfusion arrhythmias MI Fever Nausea Vomiting Cholesterol embolization Allergic reaction

Mechanism of Action

Tenecteplase is a biosynthetic form of the enzyme human tissue-type plasminogen activator (t-PA). It is a fibrin-specific thrombolytic, converts plasminogen to plasmin, a proteolytic enzyme that has fibrinolytic effects.