Streptokinase
Anticoagulant/Antiplatelet · Fibrinolytic
Indications
Acute myocardial infarction. Deep vein thrombosis, pulmonary embolism, acute or subacute occlusion of peripheral arteries, central retinal venous or arterial thromboembolism.
Dosage
Adults: Acute myocardial infarction: Single dose of 1.5 million IU by IV infusion over 1 hr. Dissolution of other thrombi and emboli: Loading dose of 250,000 IU by IV infusion, then 100,000 IU per hr for 24-72 hr, depending on condition; see literature. Acute pulmonary embolism: 3 million unit dose over 24 hr.
Administration
IM: Do not administer by IM injection. IV: For IV or intra-coronary use only. Infusion pump is required. Use in-line filter >0.8 micron. Acute MI: Dilute two 750000 unit vials of streptokinase with 5 mL D5W each, gently swirl to dissolve. Add this dose of the 1.5 million units to 150 mL D5W. This should be infused over 60 min; an in-line filter >0.45 micron should be used. Acute pulmonary embolism: Dilute four 750000 unit vials of streptokinase with 5 mL dextrose 5% in water (D5W) each, gently swirl to dissolve. Add this dose of 3 million units to 250 mL D5W, an in-line filter > 0.45 micron should be used. Administer 250000 units (23 mL) over 30 min followed by 100000 units /hour (9 mL/hour) for 24 hours. Thrombosis: Administer 250000 units to start, then 100000 units/hour for 24-72 hours depending on location. Cannula occlusion: 250000 units into cannula, clamp for 2 hours then…
Adverse Effects
Hypotension, arrhythmias. Febrile reactions, anaphylaxis (rare). Haemorrhage. Minor bleeding from puncture sites, severe haemorrhage. Pulmonary oedema. Cholesterol embolism.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Contraindicated in pregnancy. Lactation: Caution advised or effect undetermined. Contraindications: Allergy to streptokinase, recent streptokinase therapy (5 days streptokinase previously), intracranial, severe liver or kidney damage. Recent haemorrhage, haemorrhagic diathesis, severe hypotension, streptococcal infections, subacute bacterial endocarditis. Recent surgery, bleeding tendencies. Precautions: Obtain haemostatic status of patient before starting therapy. Follow up with anticoagulant therapy. Increased bleeding risk, mitral valve defect, atrial fibrillation. See literature.
Interactions
Anticoagulants, drugs affecting platelet function.
Advice to Patient
Contact prescriber if there is unusual bruising or bleeding, acute headache, joint pain, chest pain, vision changes or respiratory difficulty. To prevent bleeding, use soft toothbrush, floss with waxed floss, use electric razor, avoid scissors or sharp knives and harmful activities. Take strict bed rest to avoid injury. If bleeding occurs, report immediately and apply pressure to bleeding spot until bleeding stops completely.
Pharmacokinetics
Absorption: Oral: 0.5% ± 0.5. Metabolism: Hepatic. Half-life elimination: The elimination kinetics of streptokinase follows a biphasic course. A small proportion of the dose is bound to anti-streptokinase antibodies and metabolized with a half-life of 18 mins while most of it forms a streptokinase-plasminogen activator complex and is biotransformed with a half-life of about 80 mins. Time to peak, plasma: 20 mins. Excretion: Renal.
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
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