Urokinase


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Deep vein thrombosis; Pulmonary embolism Initial: 4,400 u/kg over 10 mins, then 4,400 u/kg/hr for 12-24 hr (deep vein thrombosis) or 12 hr (pulmonary embolism). Acute MI 2-3 million u as infusion. Peripheral arterial thromboembolism As 2,000 u/ml soln: Infuse into a clot via a catheter at a rate of 4,000 u/min for 2 hr. Monitor response using angiography. If clot is not removed, the catheter is advanced into the occluded vessel and continue infusion for another 2 hr. May repeat procedure up to 4 times if needed. If blood flow is re-established, partially remove cathether and infuse at 1,000 u/min till remaining clot has lysed. Inj Clearance of occluded catheters and shunts Instill 5,000 - 25,000 u into affected IV catheter or shunt and clamped for up to 4 hr. Aspirate the lysate and repeat the procedure if needed. Irrigation Break down of clots in hyphaema Dissolve 5,000 u in 2 mL of sterile distilled water. Irrigate the anterior chamber with 0.3 mL of the prepared soln and leave it in situ for 3 mins before washing out w/ saline. Repeat 5 times. May leave 0.3 mL in the anterior chamber for 24-48 hr if residual clot is still present at the end.
Dosage Details
Injection
Clearance of occluded catheters and shunts
Adult: 5000 - 25000 units in 2 ml sodium chloride 0.9% instilled into affected IV catheter or shunt and clamped for up to 4 hr. Aspirate the lysate and repeat the procedure if needed. Alternatively, infuse a solution containing 5000 units of urokinase in 200 mL of sodium chloride 0.9% into the device over 30 minutes.

Intravenous
Peripheral arterial thromboembolism
Adult: As solution containing 2000 units/ml: Infuse into the clot via a catheter at a rate of 4000 units/minute for 2 hr. Monitor response using angiography. If clot is not removed, advance the catheter into the occluded vessel and continue infusion at the same rate for another 2 hr. May repeat procedure, if needed, up to 4 times. Once blood flow is re-established, partially withdraw the catheter and continue infusing at 1000 units/minute until the remaining clot has lysed.

Intravenous
Pulmonary embolism
Adult: Initially, 4400 units/kg dissolved in 15 ml sodium chloride 0.9%, infused over 10 min followed by 4400 units/kg/hr for 12 hr. Alternatively, 15000 units/kg as bolus Inj into the pulmonary artery; may repeat inj, adjust dose according to plasma fibrinogen concentrations up to 3 times in 24 hr.

Intravenous
Deep vein thrombosis
Adult: Initially, 4400 units/kg dissolved in 15 ml of sodium chloride 0.9%, infused IV over 10 minutes followed by 4400 units/kg/hr for 12-24 hr.

Irrigation
Break down of clots in hyphaema
Adult: To prepare the solution: Dissolve 5000 units in 2 ml of sterile distilled water. Irrigate the anterior chamber slowly with 0.3 ml of the solution; leave solution in situ for 3 minutes and then wash out with saline. Repeat procedure 5 times. If residual clot is still present at the end of the treatment, leave 0.3 ml of the solution in the anterior chamber for 24-48 hr.

Parenteral
Acute myocardial infarction
Adult: 6000 units/min infused into the coronary artery for 2 hr preceded by IV heparin. Alternatively, 2-3 million units IV is given over 45-90 min.
Contraindications
Active internal bleeding; history of cerebrovascular accident; recent (within 2 mth) trauma of any kind including surgery; aneurysm; known bleeding diathesis; severe uncontrolled hypertension. Recent history of peptic ulcer disease, oesophageal varices, ulcerative colitis or other bleeding GI lesions; pancreatitis; subacute bacterial endocarditis; coagulation defects including those due to liver or kidney disease, or after recent surgery, childbirth or trauma. Increased risk of cerebral bleeding e.g. recent stroke or cerebral neoplasm. Pregnancy.
Special Precautions
Any vascular punctures or invasive procedures should be avoided as far as possible during, and immediately before and after urokinase therapy and if unavoidable done with great care. External chest compression. Caution in conditions eg, possibility of left heart thrombus, subacute bacterial endocarditis, coagulation defects, cerebrovascular disease, diabetic retinopathy and any conditions in which bleeding could be dangerous. Monitor for reperfusion arrhythmias when used in MI.
Adverse Reactions
Bleeding, pyrexia, haematuria, thromboembolic episodes, hypersensitivity reactions.
Potentially Fatal: Severe bleeding, anaphylaxis.
Overdosage
Symptoms: Haemorrhage. Management: Inhibitors such as tranexamic acid can be given. In serious cases, human fibrinogen, Factor XII, packed red cells or whole blood may be given as needed. Avoid using dextran for volume deficiency correction.
Drug Interactions
Reduced thrombolytic effect when given again some time later due to development of high levels of antibodies.
Potentially Fatal: Platelet inhibitors eg, aspirin and indometacin can potentiate the action of urokinase and cause haemorrhage. Heparin and oral anticoagulants may increase risk of bleeding.
Action
Description: Urokinase, an enzyme isolated from human urine, directly converts plasminogen into plasmin, which is a proteolytic enzyme with fibrinolytic effects. It is a fibrin non-specific thrombolytic as it affects both unbound and fibrin bound plasminogen.
Pharmacokinetics:
Metabolism: Hepatic; rapidly cleared from the circulation after IV administration.
Excretion: 20 min (elimination half-life).
Storage
Store below 25°C.
Disclaimer: This information is independently developed by MIMS based on Urokinase 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 © 2020 MIMS. All rights reserved. Powered by MIMS.com
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