Tenecteplase (Intravenous)

Used to dissolve blood clots, Tenecteplase re-establishes blood flow to the heart muscle and helps to minimize the effect of heart attacks.

Overview

When blood clots form in the blood vessels of the heart, they reduce or block blood flow to the muscle. As a result, patients may suffer a heart attack or an alternative medical emergency. By administering Tenecteplase, physicians can dissolve the blood clot and improve the flow of blood throughout the blood vessels.

Providing Tenecteplase is administered quickly enough, blood flow can be re-established before permanent damage has been done to the heart muscle. As a result, Tenecteplase increases the chances of survival after a heart attack and helps to reduce the permanent symptoms associated with the condition.

Given intravenously, patients receive Tenecteplase via a needle or syringe. As the medication is delivered straight into a vein, it is able to begin working immediately. Taking medications orally requires them to be broken down and, as a result, it can take far longer for them to be effective. As the presence of a blood clot requires urgent intervention, administering Tenecteplase intravenously ensures that the medication has the best chance of being effective.

As Tenecteplase is normally required in an emergency situation, it is typically given via a standard intravenous catheter. In most instances, patients will have a needle inserted into either their elbow, wrist or the back of their hand. A catheter is then pushing over the needle and remains placed in the vein while the needle is removed. The presence of a catheter means that further medication can be administered, if necessary, without the need for additional venipuncture.

Once in place, an intravenous catheter can be used to deliver medication slowly and consistently or it can facilitate the rapid administration of drugs, known as an 'IV push'. As Tenecteplase is most often required in urgent medical situations, it is typically administered via an IV push. This simply means that the medication can be delivered very quickly, as is required when the patient is suffering from acute heart problems.

When heart attacks occur, the speed of treatment is crucial to the survival of the patient. If a blood clot has caused the heart attack to occur, it must be removed or dissolved in order to allow the heart muscle to begin working properly again. By using Tenecteplase intravenously, physicians have the ability to deliver the medication in a matter of seconds, giving the patient the best chance of survival.

Conditions Treated

  • Blood clots in heart blood vessels
  • Heart attack (Myocardial Infarction) caused by blood clot

Type of Medicine

  • Thrombolytic
  • Tissue Plasminogen Activator (tPA)

Side Effects

When receiving any form of medication, patients can sometimes experience unwanted side effects. In the case of Tenecteplase, patients may experience the following:

  • Bleeding or bruising of any kind, especially around the place of injection
  • Shortness of breath and/or wheezing
  • Abdominal or stomach pain or swelling
  • Back pain or backaches
  • Vomiting of blood or material that looks like coffee grounds
  • Tightness in chest
  • Bloody or black, tarry stools
  • Wheezing
  • Cough
  • Coughing up blood
  • Bloody nose
  • Difficulty swallowing
  • Dizziness
  • Nosebleeds
  • Fast, slow or irregular heartbeat
  • Headaches
  • Hives
  • Fast, slow or irregular breathing
  • Collection of blood under the skin (may appear as bruising)
  • Skin rash, hives or itching
  • Swelling of eyes, face, lips, or tongue
  • Presence of blood in urine
  • Unusual tiredness or weakness
  • Blood in the throat
  • Constipation

If patients experience the above side effects, it's important that they discuss them with their doctor. As Tenecteplase is normally administered in a clinical setting, however, it's likely that the patient will be monitored closely once the medication has been given intravenously.

Due to this, physicians and nurses will often be aware of any side-effects which occur and will take action, if it is deemed necessary to do so. Even in a clinical setting, however, patients and their representatives should feel able to report the presence of side-effects to the relevant medical personnel.

Dosage

When prescribing Tenecteplase, doctors will determine the appropriate dose based on the individual patient. Their condition, age, weight and medical history will all affect the dosage instructions issued by the physician.

In most cases, however, 50mg of Tenecteplase powder is used to prepare the solution, ready for it to be injected. A typical dose of Tenecteplase is 30mg for patients under 60kg, 35mg for patients between 60-70kg, 40mg for patients between 70-80kg, 45mg for patients between 80-90kg and 50mg for patients over 90kg.

If the standard dosing regimen is followed, the patient should receive the medication via an IV push, over a period of 5 seconds. This ensures that the solution is allowed to take effect quickly. For the best results, Tenecteplase should be administered as soon as possible if the patient has experienced a heart attack. Furthermore, it is crucial that the patient receives Tenecteplase intravenously within 30 minutes of the heart attack so that permanent damage to the heart is avoided.

While the above information exemplifies a typical dosing strategy, doctors may feel the need to use alternative doses for some patients. As the medication is delivered in a clinic setting, such as in a hospital, patients will not have to determine the appropriate dose. Similarly, the medication will be administered by a nurse, doctor or consultant so the patient will not have to prepare the Tenecteplase solution or administer it themselves.

Potential Drug Interactions

As well as medications having an effect on the body, they can have an effect on other drugs in the patient's symptoms. In some cases, certain drugs should not be used together. In others, however, the medications can be used at the same time but the doses may need to be altered in order to prevent or reduce an interaction.

Tenecteplase may interact with Defibrotide, for example, and physicians may be unwilling to treat a patient with both of these medications. The following medications, however, may be used with Tenecteplase, despite the possibility of an interaction occurring:

  • Acenocoumarol
  • Warfarin
  • Anistreplase
  • Apixaban
  • Edoxaban
  • Argatroban
  • Bemiparin
  • Lepirudin
  • Certoparin
  • Parnaparin
  • Dalteparin
  • Danaparoid
  • Phenprocoumon
  • Ardeparin
  • Enoxaparin
  • Fondaparinux
  • Heparin
  • Bivalirudin
  • Nadroparin
  • Dabigatran Etexilate
  • Pentosan Polysulfate Sodium
  • Phenindione
  • Desirudin
  • Urokinase
  • Aspirin
  • Reteplase, Recombinant
  • Protein C
  • Rivaroxaban
  • Dipyridamole
  • Streptokinase
  • Tinzaparin
  • Reviparin
  • Alteplase, Recombinant

Although physicians may want to avoid using Tenecteplase solutions with the above medications, it may be more realistic for them to alter the dose of other medications so that Tenecteplase can be used as well. As Tenecteplase solution is administered intravenously in life-threatening situations, physicians will base their decisions on whether the benefit of using the medication outweighs the potential risks.

Warnings

If a patient is suffering from other medical problems, it may affect the suitability of treatment with Tenecteplase solution. The following conditions can affect treatment with Tenecteplase solution:

  • Blood diseases
  • Brain disease or brain tumor
  • History of unexplained bleeding
  • Heart and/or blood vessel disease
  • Bleeding problems
  • Irregular heartbeat
  • Liver problems
  • High blood pressure
  • Infection
  • Strokes and Transient Ischemic Attacks

Patients should also inform their doctor if they have recently experienced any of the following:

  • Surgical procedures, including dental surgery and outpatient treatments
  • Falls
  • Injury to the head or any other part of the body
  • Injection into a blood vessel
  • Placement of tube and/or catheter into any part of the body

In order to work effectively, intravenous Tenecteplase solution thins the blood so that the clot blocking the blood vessel is dissolved. While this can be life-saving for the patient, it may also increase bleeding in other areas of the body. Elderly patients, in particular, may suffer from bleeding following treatment with Tenecteplase. Due to this, they should be monitored carefully following treatment so that potential side effects are noted quickly.

Currently, the effect of Tenecteplase solution on pregnant patients is unclear. Although the treatment is often effective in saving the mother's life, there is a chance that the medication could have a negative impact on the unborn fetus. Physicians must, therefore, weigh the benefits of using the medication before it is prescribed.

Similarly, it is not yet known if Tenecteplase can be transferred to an infant via breastfeeding. Nursing mothers may choose to stop breastfeeding if they have received Tenecteplase intravenously and should discuss this with their physician.

Although allergic reactions to Tenecteplase are rare, doctors should be aware of the possibility of a reaction occurring. Difficulty breathing, swelling of the face, throat and lips, hives, itching and rashes can all indicate the presence of an allergic reaction. In most instances, however, allergies to Tenecteplase do respond to treatment, providing it is administered quickly. If possible, patients or their representatives should inform physicians of any allergies prior to Tenecteplase being administered.

Storage

Typically, Tenecteplase is stored in powder form and prepared as a solution as needed. When mixed with sterile water, the Tenecteplase powder will dissolve and the solution can be administered. Even if any solution is left over, the syringe, needle and excess solution should be discarded completely and not re-used.

As Tenecteplase is administered intravenously, patients will only receive the medication in a clinical setting. They will not, therefore, have to store the medication at home.

Summary

Like most medications, Tenecteplase does have the potential to interact with some other medications. Similarly, the medication may cause side-effects in some patients. Due to its efficacy, however, intravenous Tenecteplase remains a very popular form of treatment.

Furthermore, Tenecteplase is only administered by medical professionals. This means that they can monitor patients after prescribing the drug and take swift action if any side-effects do occur. Due to its use in life-threatening medical emergencies, the benefits of Tenecteplase solution often significantly outweigh any risks associated with the drug.

As the solution can be delivered within a period of just 5 seconds, via an IV push, the medication is extremely fast-acting. When the heart muscle is at risk of dying or suffering permanent damage due to the presence of a blood clot, this speed at which Tenecteplase works is vital.

Although myocardial infarctions can lead to death in some cases, it's likely that Tenecteplase will prove to be life-saving, if treatment can be administered quickly enough.

Resources
Last Reviewed:
December 25, 2017
Last Updated:
April 27, 2018
Content Source: