Streptokinase

CLINICAL USE

Fibrinolytic:Thrombolysis in DVT, PE, acute arterial thromboembolism, acute MI, thrombosed A-V shunts

DOSE IN NORMAL RENAL FUNCTION

Loading dose: 250 000 IU followed by 100 000 IU/hour for 12–72 hours (refer to SPC)Myocardial Infarction: 1.5 MIU followed by aspirinThrombosed

HD : shunts: 10–25 000 IU sealed in shunt and repeated after 30–45 minutes

PHARMACOKINETICS

Molecular weight :47 408

%Protein binding :No data

%Excreted unchanged in urine : 0

Volume of distribution (L/kg) :0.02–0.08

half-life – normal/ESRD (hrs) :18 minutes/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unlikely to be dialysed. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsAnticoagulants should not be given with streptokinaseHeparin infusions should be stopped 4 hours before streptokinase infusion. If this is not possible, protamine sulphate should be used to neutralise the heparin; heparin infusions can be restarted 4 hours post streptokinase infusion followed by oral anticoagulants

ADMINISTRATION

Reconstition

See manufacturer’s literature

Route

Rate of Administration

Give loading dose of 250 000 IU in 100 mL fluid over 30 minutes, followed by an appropriate volume for the maintenance doseGive 1.5 MIU for acute MI in 50–200 mL fluid over 1 hour

Comments

For occluded

HD : shunts, add 100 000 IU to 100 mL sodium chloride 0.9% and put 10–25 mL into the clotted portion of the shunt

OTHER INFORMATION

There are no significant changes in pharmacokinetics in patients with renal insufficiency. Dosage reduction is therefore not necessary.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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