In the U.S.—

Other commonly used names are TNK; TNK-tPA, and; TNK-tissue plasminogen activator

• Thrombolytic

Tenecteplase ( TEN-neck-te-place) is used to dissolve blood clots that have formed in the blood vessels of the heart and seriously lessen the flow of blood in the heart. This medicine is used to improve survival after a heart attack.

Tenecteplase is to be administered only by or under the immediate supervision of your doctor, it is available in the following dosage forms:

Parenteral
• Injection (U.S.)

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For tenecteplase, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to tenecteplase. Also tell your doctor and pharmacist if you are allergic to any other substances.

Pregnancy—Tenecteplase has not been studied in pregnant women. However, studies in rabbits have shown that multiple intravenous administrations of tenecteplase cause maternal and embryo toxicity, but no fetal abnormalities have been observed. Tenecteplase does not cause maternal and embryo toxicity in rabbits after a single intravenous administration. Before taking this medicine, make sure your doctor knows if you are pregnant or if you have recently had a baby.

The most common adverse effect of tenecteplase therapy is bleeding, and pregnancy can increase this risk.

Breast-feeding— It is not known whether tenecteplase passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who have been given this medicine and who wish to breast-feed should discuss this with their doctor.

Children—Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of tenecteplase in children with use in other age groups.

Older adults—The need for treatment with tenecteplase may be increased in elderly patients with blood clots. However, the chance of bleeding may also be increased. It is especially important that you discuss the use of this medicine with your doctor.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Before you receive tenecteplase, it is especially important that your doctor know if you are taking any of the following:

• Anticoagulants (blood thinners) or
• Aspirin or
• Clopidogrel (e.g., Plavix)
• Dipyridamole (e.g., Persantine) or
• Heparin or
• Ticlopidine (e.g., Ticlid) or
• Warfarin (e.g., Coumadin)—The chance of bleeding may be increased

• Blood disease, bleeding problems, or a history of bleeding in any part of the body or
• Brain disease or tumor or
• Heart or blood vessel disease, including irregular heartbeat or
• High blood pressure or
• Liver disease or
• Stroke—The chance of bleeding may be increased

• Infection—Chance of spreading the infection into the blood stream

Also, tell your doctor if you have recently had any of the following conditions:

• Falls or blow to the body or head or any other injury or
• Injections into a blood vessel or
• Placement of any tube into the body or
• Surgery of any kind, including dental surgery—The chance of serious bleeding may be increased

If you have recently had a baby, use of this medicine may cause serious bleeding.

Dosing—

The dose of tenecteplase will be different for different patients. The dose you receive will depend on your body weight.

Tenecteplase can cause bleeding that usually is not serious. However, serious bleeding may occur in some people. To help prevent serious bleeding, carefully follow any instructions given by your health care professional. Also, move around and be handled as little as possible, and do not get out of bed on your own, unless your health care professional tells you it is all right to do so.

Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines, such as aspirin.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

• More common

• Bleeding or bruising of any kind, especially around the place of injection;  collection of blood under skin 

• Less common or rare
  • Abdominal or stomach pain or swelling;  back pain or backaches;  blood in throat;  blood in urine;  bloody or black, tarry stools;  constipation;  cough ;  coughing up blood;  difficulty swallowing;  dizziness;  fast, slow or irregular breathing;  fast, slow or irregular heartbeat;  headaches;  hives;  nosebleeds;  shortness of breath and/or wheezing;  skin rash, hives or itching ;  swelling of eyes, face, lips, or tongue;  tightness in chest;  unusual tiredness or weakness;  vomiting of blood or material that looks like coffee grounds;  wheezing 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome.

• Less common
  • Bloody nose;  unexplained nosebleeds