Tenecteplase

INDICATION LIMIT OF THIS SOURCE: the fetched SPC is Metalyse 10,000 units (50 mg), and §4.2 states 'The 40 mg and 50 mg presentations are only intended for use in acute myocardial infarction.' Dosing for any other indication (including acute ischaemic stroke, which uses a different presentation) is NOT covered by this label and must be sourced separately — do not extrapolate. Should be prescribed by physicians experienced in the use of thrombolytic treatment and with the facilities to monitor that use. ELDERLY (>=75 years): administer with caution due to a higher bleeding risk. ADJUNCTIVE THERAPY: antithrombotic adjunctive therapy with platelet inhibitors and anticoagulants should be given according to current STEMI treatment guidelines; unfractionated heparin and enoxaparin were used in clinical studies; acetylsalicylic acid should be initiated as soon as possible after symptom onset and continued lifelong unless contraindicated. CORONARY INTERVENTION: if primary PCI is scheduled according to current guidelines, tenecteplase should not be given; patients who cannot undergo primary PCI within one hour and receive tenecteplase should be transferred without delay for angiography and timely adjunctive coronary intervention within 6-24 hours or earlier if medically indicated. PAEDIATRIC: safety and efficacy in children below 18 years have not been established; no data are available. US TNKase labelling gives the same weight bands in mg administered as a single intravenous bolus over 5 seconds, and notes TNKase is incompatible with dextrose-containing solutions (flush dextrose lines with saline before and after). NOTE ON SOURCES: eMC §4.5 was not captured in the fetched bundle — the interactions listed are drawn from §4.3/§4.4 and from the US label §7; clinician to check the full §4.5.