Streptokinase


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.
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.

Disclaimer: This information is independently developed by MIMS based on Streptokinase from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2022 MIMS. All rights reserved. Powered by MIMS.com
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