Stable Angina, Acute Coronary Syndromes and Fibrinolytic Drugs

Fibrinolytics

Specialist use only (S²)

TENECTEPLASE

ALTEPLASE

Prescribing Notes:

Tenecteplase is the formulary-preferred antithrombotic agent for acute ischaemic stroke presenting within 4.5 hours of symptom onset and after exclusion of intracranial haemorrhage. Use of tenecteplase should only be within a specialist acute stroke unit.
It should be noted that the different preparations for both alteplase and tenecteplase have different licensed indications.
Tenecteplase 5,000unit (25mg) powder for solution for injection vials are licensed for acute ischaemic stroke.
See NHS Lanarkshire Guidelines Hyperacute Stroke - Thrombolysis and Thrombectomy Pathway and Hyperacute Stroke – Alteplase Guidance For Patients Requiring Thrombolysis – Alternative To Tenecteplase.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S¹): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S²): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Last reviewed: 09/04/2025

Next review date: 30/06/2026

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.

Stable Angina, Acute Coronary Syndromes and Fibrinolytic Drugs

Fibrinolytics

NHSL Joint Adult Formulary Key

Editorial Information