Streptokinase: Indication, Dosage, Side Effect, Precaution

This information is not country-specific. Please refer to the Myanmar prescribing information.

Generic Medicine Info

Indications and Dosage

Intra-arterial, Intravenous
Peripheral arterial occlusive disease

Adult: Via intra-arterial infusion: Gradual infusion: 1,000-2,500 units every 3-5 minutes for a maximum of 10 hours. Max dose: 250,000 units; Prolonged continuous low-dose infusion: 5,000-10,000 units hourly. Max treatment duration: 5 days. As an alternative for difficult arterial access or due to multiple occlusions; Initial: 250,000 units over 30 minutes via IV infusion. Maintenance infusion: 100,000 units hourly for up to 5 days.

Intravenous
Acute myocardial infarction

Adult: Within 12 hours of onset with persistent ST-segment elevation or recent left bundle-branch block: 1,500,000 units as a single dose via infusion over 60 minutes.

Intravenous
Deep vein thrombosis

Adult: Initially, 250,000 units via infusion over 30 minutes. Maintenance infusion: 100,000 units hourly for 72 hours.

Intravenous
Pulmonary embolism

Adult: Initially, 250,000 units via infusion over 30 minutes. Maintenance infusion: 100,000 units hourly for 24 hours. Alternatively, 1,500,000 units over 1-2 hours.

Intravenous
Central retinal artery thrombosis, Central retinal vein thrombosis

Adult: Initially, 250,000 units via infusion over 30 minutes. Maintenance infusion: 100,000 units hourly for 12 hours.

Renal Impairment

Severe: Contraindicated.

Hepatic Impairment

Severe: Contraindicated.

Reconstitution

Reconstitute with 4-5 mL of 0.9% NaCl or sterile water for inj. Gently swirl and avoid foaming.

Contraindications

Existing or recent internal haemorrhage, intracranial neoplasm or other neoplasms with risk of haemorrhage, arteriovenous malformation or aneurysm, recent CVA, recent head trauma, intracranial or intraspinal surgery, known haemorrhagic diathesis, spontaneous fibrinolysis and extensive clotting disorders, severe uncontrolled hypertension (>200 mmHg systolic values, >100mmHg diastolic values), hypertensive retinopathy, endocarditis or pericarditis, acute pancreatitis, recent major operation (6th-10th post-operative day), recent invasive operation (e.g. recent organ biopsy, closed chest cardiac massage, implantation of a vessel prosthesis). Severe hepatic and renal impairment. Pregnancy. Recent or concomitant anticoagulant therapy (INR >1.3).

Special Precautions

Patient with severe arteriosclerotic vessel degeneration, cerebrovascular disease, recent severe gastrointestinal bleeding (e.g. active peptic ulcer), increased risk of left heart thrombus (e.g. mitral valve defect, atrial fibirillation), open tuberculosis or severe bronchitis, diabetic haemorrhagic retinopathy, septic thrombophlebitis. Recent intubation, trauma and cardiopulmonary resuscitation; previous puncture of non-compressible vessels; undergoing translumbar aortography; with indwelling urethral catheter; obstetrical delivery or operation (including miscarriage); aortic dissection, and any other condition in which bleeding poses a hazard or would cause difficult management due to location. Elderly. Lactation.

Adverse Reactions

Significant: Coronary thrombolysis; hypotension, tachycardia and/or bradycardia during initial infusion. Rarely, anaphylactic reactions.
Cardiac disorders: Angina pectoris, heart failure, reinfarction, cardiogenic shock, pericarditis.
Gastrointestinal disorders: Nausea, vomiting, diarrhoea, epigastric pain, gastrointestinal bleeding.
General disorders and administration site conditions: Injection site bleeding, ecchymoses, chills, fever, asthenia, malaise.
Immune system disorders: Antistreptokinase antibody development.
Musculoskeletal and connective tissue disorders: Musculoskeletal pain.
Nervous system disorders: Headache.
Renal and urinary disorders: Genitourinary bleeding.
Respiratory, thoracic and mediastinal disorders: Pulmonary oedema.
Potentially Fatal: Haemorrhage.

Pregnancy Category (US FDA)

Intra-arterial/Intracoronary/IV/Parenteral: C

Monitoring Parameters

Monitor blood pressure, heart rate, ECG, PT/INR, aPTT, CBC, and fibrinogen levels. Assess for signs of bleeding.

Drug Interactions

Increased risk of haemorrhage with drugs that inhibit platelet function (e.g. platelet aggregation inhibitors, dextrans).
Potentially Fatal: Increased risk of haemorrhage with anticoagulants (e.g. heparin).

Action

Description: Streptokinase is a thrombolytic drug that is derived from various streptococci. It forms a streptokinase-plasminogen complex which rapidly converts plasminogen to plasmin. Plasmin in turn, degrades fibrin, fibrinogen and other procoagulant proteins into soluble fragments.
Onset: Fibrinolytic activity: Approx 20 minutes.
Pharmacokinetics:
Metabolism: Metabolised in the liver via proteolysis.
Excretion: Via urine (as peptides). Elimination half-life: 80 minutes (streptokinase-plasminogen activator complex).

Storage

Store intact vials below 25°C. Do not freeze. Reconstituted solutions are stable for 24 hours between 2-8°C.

MIMS Class

Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)

ATC Classification

B01AD01 - streptokinase ; Belongs to the class of enzymes. Used in the treatment of thrombosis.

References

Anon. Streptokinase. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/12/2020.

Buckingham R (ed). Streptokinase. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/12/2020.

Fibrion Powder for Solution for Infusion (Lyocontract GmbH). MIMS Indonesia. http://www.mims.com/indonesia. Accessed 11/12/2020.

Joint Formulary Committee. Streptokinase. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/12/2020.

ST-Pase (Cadila Pharmaceuticals Limited). MIMS Philippines. http://www.mims.com/philippines. Accessed 11/12/2020.

Streptokinase Karma 1 500 000 (Karma-Medica GmbH). MHRA. https://products.mhra.gov.uk. Accessed 11/12/2020.

Streptokinase Karma 250 000 (Karma-Medica GmbH). MHRA. https://products.mhra.gov.uk. Accessed 11/12/2020.

Streptokinase Karma 750 000 (Karma-Medica GmbH). MHRA. https://products.mhra.gov.uk. Accessed 11/12/2020.

Streptokinase. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 11/12/2020.

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