Tenecteplase
TNKASE
What it isBioengineered tPA variant with greater fibrin specificity and a longer half-life; STEMI and, increasingly, ischemic stroke.
Why this oneA single bolus replaces alteplase’s infusion, which matters when transferring a stroke patient.
What limits itSame hemorrhage risk and same time window. Dosing differs from alteplase — the two are not interchangeable by volume.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute ischemic stroke (AIS) | Adults | Weight-based single IV bolus over 5 sec (<60 kg 15 mg; 60–<70 17.5 mg; 70–<80 20 mg; 80–<90 22.5 mg; ≥90 25 mg), within 3 h of symptom onset | Single bolus | 25 mg |
| Acute ST elevation myocardial infarction (STEMI) | Adults | Weight-based single IV bolus over 5 sec (<60 kg 30 mg; 60–<70 35 mg; 70–<80 40 mg; 80–<90 45 mg; ≥90 50 mg) | Single bolus | 50 mg |
Renal Undefined
Hepatic Undefined
Single-dose only
Instructions
- IV single bolus over 5 seconds
- Reconstitute to 5 mg/mL with supplied Sterile Water; do not shake
- Flush dextrose-containing IV lines with 0.9% NaCl before and after (incompatible with dextrose)
- AIS: initiate within 3 h of symptom onset; frequently monitor and control blood pressure
Contraindications
- Active internal bleeding
- Intracranial or intraspinal surgery or trauma within 2 months
- Known bleeding diathesis
- Current severe uncontrolled hypertension
- Presence of intracranial conditions that may increase the risk of bleeding (e.g., intracranial neoplasm, arteriovenous malformation, or aneurysm)
- AIS: Active intracranial hemorrhage
- STEMI: History of intracranial hemorrhage
- STEMI: History of ischemic stroke within 3 months
Cautions
- Bleeding (can be significant and fatal); avoid IM injections and minimize punctures
- Hypersensitivity, including anaphylaxis; monitor during and for several hours after
- Thromboembolism in patients with high likelihood of left heart thrombus
- Cholesterol embolization
- Arrhythmias with reperfusion
- STEMI with planned PCI: increased heart failure and recurrent ischemia
Adverse reactions
- Bleeding (most common)
- Symptomatic intracerebral hemorrhage
- Extracranial bleeding requiring transfusion
- Orolingual angioedema
Pregnancy No human data; related thrombolytics not shown to increase birth defects; STEMI/AIS are life-threatening emergencies — do not withhold life-sustaining therapy
Lactation No data on presence in milk; weigh benefits of breastfeeding against clinical need
NO BOXED WARNINGS
Principal riskIntracranial hemorrhage; dosing differs from alteplase
Classes and tags
Clinical profile
Mechanism of action: Tenecteplase ballicule
