diff --git a/dev-packages/e2e-tests/test-applications/node-koa-app/index.js b/dev-packages/e2e-tests/test-applications/node-koa-app/index.js
index 3ee16ab7200e..9d58bd6ca3b6 100644
--- a/dev-packages/e2e-tests/test-applications/node-koa-app/index.js
+++ b/dev-packages/e2e-tests/test-applications/node-koa-app/index.js
@@ -75,6 +75,10 @@ router1.get('/test-exception', async ctx => {
   throw new Error('This is an exception');
 });
 
+router1.get('/test-exception/:id', async ctx => {
+  throw new Error(`This is an exception with id ${ctx.params.id}`);
+});
+
 router1.get('/test-outgoing-fetch-external-allowed', async ctx => {
   const fetchResponse = await fetch(`http://localhost:${port2}/external-allowed`);
   const data = await fetchResponse.json();
diff --git a/dev-packages/e2e-tests/test-applications/node-koa-app/tests/errors.test.ts b/dev-packages/e2e-tests/test-applications/node-koa-app/tests/errors.test.ts
index 1d6cf604f176..5759c2bad543 100644
--- a/dev-packages/e2e-tests/test-applications/node-koa-app/tests/errors.test.ts
+++ b/dev-packages/e2e-tests/test-applications/node-koa-app/tests/errors.test.ts
@@ -41,11 +41,11 @@ test('Sends exception to Sentry', async ({ baseURL }) => {
 
 test('Sends correct error event', async ({ baseURL }) => {
   const errorEventPromise = waitForError('node-koa-app', event => {
-    return !event.type && event.exception?.values?.[0]?.value === 'This is an exception';
+    return !event.type && event.exception?.values?.[0]?.value === 'This is an exception with id 123';
   });
 
   try {
-    await axios.get(`${baseURL}/test-exception`);
+    await axios.get(`${baseURL}/test-exception/123`);
   } catch {
     // this results in an error, but we don't care - we want to check the error event
   }
@@ -53,16 +53,16 @@ test('Sends correct error event', async ({ baseURL }) => {
   const errorEvent = await errorEventPromise;
 
   expect(errorEvent.exception?.values).toHaveLength(1);
-  expect(errorEvent.exception?.values?.[0]?.value).toBe('This is an exception');
+  expect(errorEvent.exception?.values?.[0]?.value).toBe('This is an exception with id 123');
 
   expect(errorEvent.request).toEqual({
     method: 'GET',
     cookies: {},
     headers: expect.any(Object),
-    url: 'http://localhost:3030/test-exception',
+    url: 'http://localhost:3030/test-exception/123',
   });
 
-  expect(errorEvent.transaction).toEqual('GET /test-exception');
+  expect(errorEvent.transaction).toEqual('GET /test-exception/:id');
 
   expect(errorEvent.contexts?.trace).toEqual({
     trace_id: expect.any(String),
diff --git a/packages/node/src/integrations/tracing/koa.ts b/packages/node/src/integrations/tracing/koa.ts
index 2c3a57ebed3f..938e815e2b2f 100644
--- a/packages/node/src/integrations/tracing/koa.ts
+++ b/packages/node/src/integrations/tracing/koa.ts
@@ -1,14 +1,39 @@
 import { registerInstrumentations } from '@opentelemetry/instrumentation';
 import { KoaInstrumentation } from '@opentelemetry/instrumentation-koa';
-import { captureException, defineIntegration } from '@sentry/core';
+import { SemanticAttributes } from '@opentelemetry/semantic-conventions';
+import {
+  captureException,
+  defineIntegration,
+  getDefaultIsolationScope,
+  getIsolationScope,
+  spanToJSON,
+} from '@sentry/core';
 import type { IntegrationFn } from '@sentry/types';
+import { logger } from '@sentry/utils';
+import { DEBUG_BUILD } from '../../debug-build';
 
 const _koaIntegration = (() => {
   return {
     name: 'Koa',
     setupOnce() {
       registerInstrumentations({
-        instrumentations: [new KoaInstrumentation()],
+        instrumentations: [
+          new KoaInstrumentation({
+            requestHook(span, info) {
+              if (getIsolationScope() === getDefaultIsolationScope()) {
+                DEBUG_BUILD &&
+                  logger.warn('Isolation scope is default isolation scope - skipping setting transactionName');
+                return;
+              }
+              const attributes = spanToJSON(span).data;
+              const route = attributes && attributes[SemanticAttributes.HTTP_ROUTE];
+              const method = info.context.request.method.toUpperCase() || 'GET';
+              if (route) {
+                getIsolationScope().setTransactionName(`${method} ${route}`);
+              }
+            },
+          }),
+        ],
       });
     },
   };