METALYSE should be administered on the basis of body weight, with a maximum dose of 10,000 units (tenecteplase 50 mg). The volume required to administer the correct dose can be calculated from the following scheme (see Table 4):
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The required dose should be administered as a single intravenous bolus over 5 to 10 seconds.
A pre-existing intravenous line, which has been used for administration of 0.9% sodium chloride solution only, may be used for administration of METALYSE. If a line is used, this line should be flushed after METALYSE injection for proper delivery.
METALYSE is incompatible with dextrose solution.
METALYSE should not be mixed with other drugs, neither in the same infusion-vial nor the same venous line (not even with heparin).
Adjunctive therapy: Antithrombotic adjunctive therapy is recommended according to the current international guidelines for the management of patients with ST-elevation myocardial infarction.
For coronary intervention, refer to Precautions.
Instructions for use/handling: METALYSE should be reconstituted by adding the complete volume of water for injections from the pre-filled syringe to the vial containing the powder for injection.
1. Ensure that the appropriate vial size is chosen according to the body weight of the patient (see Table 4).
2. Check that the cap of the vial is still intact.
3. Remove the flip-off cap from the vial.
4. Remove the tip-cap from the syringe. Then immediately screw the pre-filled syringe on the vial adapter and penetrate the vial stopper in the middle with the spike of the vial adapter.
5. Add the water for injections into the vial by pushing the syringe plunger down slowly to avoid foaming.
6. Reconstitute by swirling gently.
7. The reconstituted preparation is a colourless to pale yellow, clear solution. Only clear solution without particles should be used.
8. Directly before the solution is administered, invert the vial with the syringe still attached, so that the syringe is below the vial.
9. Transfer the appropriate volume of reconstituted solution of METALYSE into the syringe, based on the patient's weight.
10. Disconnect the syringe from the vial adapter.
11. METALYSE should be administered to the patient, intravenously over 5 to 10 seconds. It should not be administered into a line containing dextrose.
12. Any unused solution should be discarded.
13. Alternatively the reconstitution can be performed with the included needle.