tenecteplase (Rx)

Brand and Other Names:TNK tPA, TNKase
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 50mg

Acute MI

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

Restore Function to Hemodialysis Catheters (Orphan)

Indicated to restore function to hemodialysis catheters

Orphan indication sponsor

  • Genentech, Inc; 1 DNA Way; South San Francisco, CA 94080-4990

Safety & efficacy not established

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Interactions

Interaction Checker

and tenecteplase

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (2)

            • defibrotide

              defibrotide increases effects of tenecteplase by pharmacodynamic synergism. Contraindicated. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. This does not include use for routine maintenance or reopening of central venous lines.

            • prothrombin complex concentrate, human

              tenecteplase, prothrombin complex concentrate, human. pharmacodynamic antagonism. Contraindicated.

            Serious - Use Alternative (4)

            • apixaban

              tenecteplase and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • reteplase

              reteplase and tenecteplase both increase anticoagulation. Avoid or Use Alternate Drug.

            • warfarin

              warfarin and tenecteplase both increase anticoagulation. Avoid or Use Alternate Drug.

            • zanubrutinib

              tenecteplase, zanubrutinib. Either increases effects of the other by anticoagulation. Avoid or Use Alternate Drug. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

            Monitor Closely (77)

            • agrimony

              tenecteplase and agrimony both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alfalfa

              tenecteplase and alfalfa both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alteplase

              alteplase and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • American ginseng

              tenecteplase and American ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • anamu

              tenecteplase and anamu both increase anticoagulation. Use Caution/Monitor.

            • antithrombin alfa

              antithrombin alfa and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • antithrombin III

              antithrombin III and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • argatroban

              argatroban and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • aspirin

              aspirin, tenecteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • aspirin rectal

              aspirin rectal and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, tenecteplase. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • azficel-T

              azficel-T, tenecteplase. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.

            • bivalirudin

              bivalirudin and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • caplacizumab

              caplacizumab, tenecteplase. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            • celecoxib

              celecoxib and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cinnamon

              tenecteplase and cinnamon both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cordyceps

              tenecteplase and cordyceps both increase anticoagulation. Modify Therapy/Monitor Closely.

            • dabigatran

              dabigatran and tenecteplase both increase anticoagulation. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

            • dalteparin

              dalteparin and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • danshen

              tenecteplase and danshen both increase anticoagulation. Use Caution/Monitor.

            • devil's claw

              tenecteplase and devil's claw both increase anticoagulation. Use Caution/Monitor.

            • diclofenac

              diclofenac and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • diflunisal

              diflunisal and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • dong quai

              tenecteplase and dong quai both increase anticoagulation. Modify Therapy/Monitor Closely.

            • enoxaparin

              enoxaparin and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • epoprostenol

              tenecteplase and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

            • etodolac

              etodolac and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • fennel

              tenecteplase and fennel both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenoprofen

              fenoprofen and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • feverfew

              tenecteplase and feverfew both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fish oil

              fish oil, tenecteplase. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of tenecteplase by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

            • flurbiprofen

              flurbiprofen and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • fondaparinux

              fondaparinux and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • forskolin

              tenecteplase and forskolin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • garlic

              tenecteplase and garlic both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ginger

              tenecteplase and ginger both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ginkgo biloba

              tenecteplase and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

            • green tea

              green tea, tenecteplase. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

            • heparin

              heparin and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • horse chestnut seed

              tenecteplase and horse chestnut seed both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ibrutinib

              ibrutinib will increase the level or effect of tenecteplase by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

            • ibuprofen

              ibuprofen and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ibuprofen IV

              ibuprofen IV and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • imatinib

              imatinib, tenecteplase. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents.

            • indomethacin

              indomethacin and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ketoprofen

              ketoprofen and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ketorolac

              ketorolac and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ketorolac intranasal

              ketorolac intranasal and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • meclofenamate

              meclofenamate and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • mefenamic acid

              mefenamic acid and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • melatonin

              melatonin increases effects of tenecteplase by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

            • meloxicam

              meloxicam and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • mistletoe

              tenecteplase increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • nabumetone

              nabumetone and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • naproxen

              naproxen and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • nettle

              tenecteplase increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • nitroglycerin rectal

              nitroglycerin rectal decreases effects of tenecteplase by Other (see comment). Use Caution/Monitor. Comment: Caution should be observed in patients receiving nitroglycerin during t-PA therapy. IV administration of nitroglycerin decreases the thrombolytic effect of tissue-type plasminogen activator (t-PA). Plasma levels of t-PA are reduced when coadministered with nitroglycerin. .

            • omega 3 carboxylic acids

              omega 3 carboxylic acids, tenecteplase. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • omega 3 fatty acids

              omega 3 fatty acids, tenecteplase. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • oxaprozin

              oxaprozin and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • panax ginseng

              tenecteplase and panax ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • pau d'arco

              tenecteplase and pau d'arco both increase anticoagulation. Modify Therapy/Monitor Closely.

            • phytoestrogens

              tenecteplase and phytoestrogens both increase anticoagulation. Modify Therapy/Monitor Closely.

            • piroxicam

              piroxicam and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • reishi

              tenecteplase and reishi both increase anticoagulation. Modify Therapy/Monitor Closely.

            • rivaroxaban

              rivaroxaban, tenecteplase. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

            • salicylates (non-asa)

              salicylates (non-asa) and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • salsalate

              salsalate and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • Siberian ginseng

              tenecteplase and Siberian ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulindac

              sulindac and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • ticagrelor

              ticagrelor, tenecteplase. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.

            • tolmetin

              tolmetin and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.

            • tranexamic acid oral

              tranexamic acid oral, tenecteplase. Either decreases effects of the other by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.

            • vorapaxar

              tenecteplase, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • vortioxetine

              tenecteplase, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            Minor (1)

            • ceftaroline

              ceftaroline increases effects of tenecteplase by Other (see comment). Minor/Significance Unknown. Comment: Cephalosporins with a methylthiotetrazole (MTT) side ring (eg, cefotetan, cefoperazone) are more frequently associated with hypoprothrombinemic activity.

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            Adverse Effects

            >10%

            Minor bleeding (22%)

            Frequency Not Defined

            Reperfusion arrhythmias

            MI

            Fever

            Nausea

            Vomiting

            Cholesterol embolization

            Allergic reaction

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            Warnings

            Contraindications

            Hypersensitivity

            Active bleeding, history of CVA, recent (within 2 months) intracranial or intraspinal surgery or trauma, intracranial neoplasm, AVM, aneurysm, bleeding diathesis, severe uncontrolled HTN, recent (within 3 mth) facial trauma, suspected aortic dissection

            See thrombolytic indications/contraindications

            Cautions

            Use caution in patients with recent major surgery, cerebrovascular disease, recent GI or GU bleeding, HTN, acute pericarditis, subacute endocarditis, hemostatic defects, high likelihood of left heart thrombus (such as patients with mitral stenosis or atrial fibrillation), severe thrombophlebitis, severe hepatic/renal dysfunction, currently receiving oral anticoagulants, diabetic hemorrhagic retinopathy, elderly, recent admin of GP IIb/IIIa inhibitors

            Acute pericarditis, subacute endocarditis

            Ischemic Stroke: may have no benefit if used after 3 hr of onset

            Current use of warfarin and INR in high range may increase bleeding risk; concomitant heparin or antiplatelet agents should be discontinued immediately and treated appropriately

            Monitor potential bleeding sites

            Cholesterol embolism reported

            Pregnancy or breastfeeding

            Adjuncts for MI treatment

            Hypersensitivity, including urticarial / anaphylactic reactions, reported after administration (e.g., anaphylaxis, angioedema, laryngeal edema, rash, and urticaria); monitor patients treated with TNKase during and for several hours after infusion; if symptoms of hypersensitivity occur, initiate appropriate therapy

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            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

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Genetically engineered variant of alteplase with multiple point mutations of tPA molecule resulting in longer plasma half-life, enhanced fibrin specificity, & increased resistance to inactivation by plasminogen activator inhibitor 1 (PAI-1) compared to alteplase

            Promotes thrombolysis by converting plasminogen to plasmin which degrades fibrin & fibrinogen

            Pharmacokinetics

            Half-Life: 90-130 min

            Onset: 30 min

            Metabolism: Liver

            Metabolites: Degradation products (constituent amino acids of tenecteplase)

            Total Body Clearance: 99-119 mL/min

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            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.

            Do not discard shield assembly

            Use immediately or may be refrigerated up to 8 hr

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            TNKase intravenous
            -
            50 mg kit

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            tenecteplase intravenous

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.