EMed

Tenecteplase in Stroke (CUH)

Presentation

Tenecteplase (Metalyse®) 25mg.

Each 25mg vial contains 5,000 units tenecteplase.

Indication

Acute ischaemic stroke.

Print version Tenecteplase (stroke) preparation.

Dose

0.25 mg / kg IV bolus over 5 seconds
(Maximum dose 25 mg).

Calculate the total weight based dose of tenecteplase using table 1 below.

Weight (kg) Dose (mg) Dose (mL)
40 10 2.0
42 10.5 2.1
44 11 2.2
46 11.5 2.3
48 12 2.4
50 12.5 2.5
52 13 2.6
54 13.5 2.7
56 14 2.8
58 14.5 2.9
60 15 3.0
62 15.5 3.1
64 16 3.2
66 16.5 3.3
68 17 3.4
70 17.5 3.5
Weight (kg) Dose (mg) Dose (mL)
72 18 3.6
74 18.5 3.7
76 19 3.8
78 19.5 3.9
80 20 4.0
82 20.5 4.1
84 21 4.2
86 21.5 4.3
88 22 4.4
90 22.5 4.5
92 23 4.6
94 23.5 4.7
96 24 4.8
98 24.5 4.9
100 25 5.0

Print version Tenecteplase (stroke) preparation.

Reconstitution

  • Add 5ml volume of sterile water for injection to the vial containing the powder for injection
  • Keep syringe attached and agitate the mixture by gently swirling, inverting or rolling the vial
  • Do NOT shake the vial. Ensure powder is dissolved, only use clear solution with no particles
  • The reconstituted solution contains 5mg tenecteplase per mL
  • Using above weight based table, only withdraw dose to be administered into syringe
  • Print version Tenecteplase (stroke) preparation

Administration

  • Give the total dose as an IV bolus over 5 seconds
  • Flush prior to, & following admin. with 10ml sterile NaCl
  • Not compatible with IV lines containing glucose

Documentation

  • The total tenecteplase dose given must be documented in the patients prescription kardex
  • The time of administration must be recorded

Rules of 5s

5 mg/ml 5 ml max dose 5 flush 5 Administer 5 flush
Reconstitute 25mg vial with 5ml sterile water 5ml max dose
0.25mg / kg (max 25mg per 5ml)		 Flush with IV saline before admin. Admin. bolus over 5 seconds Flush with IV saline after admin.

Monitoring

  • Document vital signs and neurological assessments every 15 minutes for 2 hrs
  • Then every 30 minutes for the next 6 hours
  • Then every hour for the next 16 hours
  • Documents any changes in neurological condition (develops severe headache, acute ⇑BP/or ↓BP, nausea or vomiting, or decrease consciousness) and inform Stroke/ Neuroradiology team immediately

Storing

  • Store at room temperature
  • Available in Radiology Department (Tenecteplase box, kept at back of main CT), and on Stroke 3
  • Administer stat once reconstituted but is stable if kept reconstituted in fridge for 24 hours

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 16/06/24.