Streptokinase, 1500000 me

Streptokinase is an enzyme preparation obtained from a culture of b-hemolytic group C streptococcus. The drug has fibrinolytic activity, which is due to the ability to interact with blood plasminogen. Streptokinase complex with plasminogen has proteolytic activity and catalyzes the transformation of plasminogen into plasmin.

The latter is able to cause lysis of fibrin in blood clots, inactivate fibrinogen as well as factors V and VII of blood clotting. Streptokinase activity is determined by the ability of the drug to lysis under certain conditions the fibrin clot formed by a mixture of fibrinogen and thrombin solutions, and is expressed in international (international) units (IU or IU).

Streptokinase is used to restore patency of thrombosed blood vessels; the drug causes lysis of clots, acting on them not only from the surface, but also penetrating inside the thrombus (especially for fresh thromboses).

Pharmacokinetics

The elimination half-life after intravenous administration of 1500000 IU streptokinase is 1 hour; the streptokinase-plasminogen complex is about 23 minutes. It is biotransformed in the liver by hydrolysis. It is excreted in small amounts by the kidneys. In liver diseases clearance is delayed, renal failure does not affect clearance.

Indications

Active ingredient

Composition

In 1 vial contains:

Streptokinase 1500000 IU.

How to take, the dosage

Streptokinase is administered intravenously by drip, and if necessary intraarterially.

Intravenously, an initial dose of 250,000 IU in 50 ml of isotonic sodium chloride solution is usually given for 30 minutes (30 drops per minute). This dose usually initiates clot lysis. Streptokinase is then continued at a dose of 100,000 IU per hour. The total duration of administration is usually 16-18 hours. Subsequent treatment is with heparin and indirect anticoagulants.

In case of extensive arterial and venous thrombosis, sometimes prolonged administration of the drug is necessary.

Intra-arterial administration of streptokinase is used in the acute period of myocardial infarction (initial dose of 20000 IU; maintenance dose of 2000-4000 IU per minute for 30-90 minutes).

In all cases, streptokinase administration should be started as early as possible, because the best effect is seen with fresh clots.

Streptokinase treatment is performed under control of thrombin time and blood fibrinogen content.

Interaction

Heparin, coumarin derivatives, dipyridamole, NSAIDs, including acetylsalicylic acid, dextrans, valproic acid increase the anticoagulation effect and increase the risk of bleeding.

Incompatible with plasma replacement solutions – hydroxyethylated starch and dextran.

Special Instructions

The treatment is carried out under control of thrombin or partial thromboplastin time values. With particular caution use in marked liver and renal dysfunction, diabetes mellitus, bronchial asthma, previous streptococcal infection, including rheumatism, bronchiectasis with hemoptysis, dilated esophageal veins, recent administration of anticoagulants, conditions after cardiopulmonary resuscitation, ventilatory ventilation, bleeding accompanying urological diseases, including urolithiasis, as well as chronic GI diseases, menorrhagia, menstrual bleeding, previous (5 days to 1 year) course of streptokinase treatment, in old age (over 75 years).

The drug is used in a hospital setting.

Contraindications

The drug is contraindicated in:

Side effects

When using streptokinase nonspecific reactions to the protein may develop: headache, nausea, chills, allergic reactions (corticosteroids are recommended for severe allergic reactions).

In case of rapid intravenous administration, hypotension and cardiac arrhythmias may develop. The possibility of embolism should be considered (due to mobilization of thrombus elements).

Overdose

Symptoms: increased side effects (most often – bleeding)

Treatment: stop bleeding (if possible), administration of antifibrinolytic agents (tranexamic acid, para-aminomethylbenzoic acid, kallikrein or protease inhibitors, including aprotinin, aminopropic acid – 5 g/h, then 1 g/h for 4-8 hours to achieve effect.including aprotinin, aminocaproic acid – 5 g/h, then 1 g/h for 4-8 hours until the effect is achieved), blood loss replacement (except dextran and hydroxyethylated starch), symptomatic treatment.