Section 13 · Monograph
Tenecteplase
Reviewed Nov 2026FDA label
TNKaseThrombolytic (tPA)
- Forms
- IV: 25, 50mg vials
- Dose
- Acute ischemic stroke: single IV bolus over ~5 sec, 0.25mg/kg (max 25mg): under 60kg 15mg | 60 to <70kg 17.5mg | 70 to <80kg 20mg | 80 to <90kg 22.5mg | 90kg+ 25mg
- MOA
- Fibrin-specific plasminogen activator
Indications
- Acute ischemic stroke in adults (FDA-approved March 2025)FDA-labeled
- Acute ST-elevation myocardial infarction to reduce mortalityFDA-labeled
Mechanism of Action
- Genetically modified tPA; fibrin-specific plasminogen activator with a longer half-life, allowing single-bolus dosing
Full Dosing
Adult / usual
- Stroke: single IV bolus over about 5 seconds, 0.25mg/kg, max 25mg — under 60kg 15mg; 60 to <70kg 17.5mg; 70 to <80kg 20mg; 80 to <90kg 22.5mg; 90kg or more 25mg
- Do NOT use the higher STEMI weight-band doses (30-50mg) for stroke
- Flush IV line with saline before and after; incompatible with dextrose-containing solutions
- Treat within the guideline-supported window (up to 4.5 hours in eligible patients); confirm against current label
Contraindications
- Active internal bleeding
- Intracranial or intraspinal surgery or serious head trauma within 3 months; prior intracranial hemorrhage; intracranial neoplasm, AVM or aneurysm
- Severe uncontrolled hypertension
- Bleeding diathesis; INR above 1.7 or recent anticoagulant use
Drug Interactions
- Anticoagulants and antiplatelets increase bleeding risk
- Incompatible with dextrose solutions
Adverse Effects
- Intracranial hemorrhage
- Major systemic bleeding
- Angioedema
- Reperfusion arrhythmias (MI)
Monitoring Parameters
- Neuro checks and BP as for alteplase; BP below 185/110 before and below 180/105 for 24 hours after
- Repeat CT at 24 hours before antithrombotics
- Stop and image urgently for neurologic worsening or severe headache
Pregnancy & Lactation
- Limited data; use only if benefit outweighs risk