Tenecteplase Weight-Based Dosing
Administer tenecteplase as a single IV bolus based on patient weight: 30 mg for <60 kg, 35 mg for 60-69 kg, 40 mg for 70-79 kg, 45 mg for 80-89 kg, and 50 mg for ≥90 kg. 1, 2
Dosing Algorithm
The 2025 ACC/AHA/ACEP/NAEMSP/SCAI guidelines and FDA labeling provide clear weight-stratified dosing 1, 2:
- <60 kg: 30 mg (6 mL from reconstituted vial)
- 60 to <70 kg: 35 mg (7 mL)
- 70 to <80 kg: 40 mg (8 mL)
- 80 to <90 kg: 45 mg (9 mL)
- ≥90 kg: 50 mg (10 mL)
Administration Details
Give as a single IV bolus over 5 seconds after reconstituting the 50 mg vial with 10 mL sterile water to achieve 5 mg/mL concentration 2. This represents a major practical advantage over alteplase, which requires a 90-minute weight-based infusion 1.
Critical Administration Points:
- Flush dextrose-containing IV lines with 0.9% sodium chloride before and after administration—tenecteplase precipitates with dextrose 2
- Use immediately after reconstitution, or refrigerate at 2-8°C and use within 8 hours 2
- Administer directly into IV port using sterile technique 2
Clinical Context
Tenecteplase demonstrates equivalent 30-day mortality to alteplase in acute MI but with reduced noncerebral bleeding 1. The fibrin-specific design provides superior patency rates compared to non-fibrin-specific agents 1.
Important Caveats:
Do not adjust dosing based on ideal body weight or body surface area—use actual body weight only 1, 2. The pharmacokinetics show that total body weight explains 19% of plasma clearance variability, and the dosing tiers account for this 2.
Maximum dose is 50 mg regardless of weight 1, 2. Patients ≥90 kg receive the same 50 mg dose as those weighing 90-100+ kg.
The weight-based bolus dosing makes tenecteplase particularly advantageous in time-critical STEMI situations where rapid administration is essential for mortality reduction 1.