Streptokinase

Streptokinase is an Anticoagulant agent belonging to the Thrombolytic class.

Streptokinase is used in the treatment of acute ST-segment myocardial infarction, deep vein thrombosis, pulmonary embolism, arterial thrombosis or embolism, and arteriovenous cannula occlusion.

Streptokinase is metabolized in the liver via proteolysis and gets excreted via urine (as peptides). The elimination half-life was 80 minutes (streptokinase-plasminogen activator complex).

The onset of Action of Streptokinase is within 20 minutes.

The Duration of action of Streptokinase is 4 – 12 hours.

The Tmax of Streptokinase about 20 minutes after dosing and the Cmax of Streptokinase was found within 10.1 ± 5.6 ng/ml

The common side effects are dizziness, drowsiness, headache, weakness, Nausea, strong irregular heartbeat, swelling, and dizziness upon standing.

Streptokinase is available in a dosage form, such as injection.

Streptokinase is available in the USA, UK, Canada, Japan, and India.

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.

Streptokinase is available in a dosage form, such as an injection.

Instill 250,000 IU Streptokinase in 2 mL of solution into each occluded limb of the cannula slowly. Clamp off cannula limb(s) for 2 hours. Observe the patient closely for possible adverse effects. After treatment, aspirate contents of infused cannula limb(s), flush with saline, and reconnect the cannula.

Streptokinase is used in the treatment of acute ST-segment myocardial infarction, deep vein thrombosis, pulmonary embolism, arterial thrombosis or embolism, and arteriovenous cannula occlusion.

Streptokinase is a polypeptide derived from beta-hemolytic streptococci of Lancefield group C bacteria. It forms a complex with plasminogen, which then converts to the proteolytic enzyme plasmin. This process results in a cascade that ultimately leads to the lysis of fibrin clots. Streptokinase causes a systemic thrombolytic state that usually resolves within 48 hours of administration.

Streptokinase is approved for its use in the following clinical indications:

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.

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.

Central retinal vein thrombosis

Adult: Initially, 250,000 units via infusion over 30 minutes. Maintenance infusion: 100,000 units hourly for 12 hours.

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: 5000-10,000 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.

Streptokinase is available in various dosage strengths: 250000 intl units; 1500000 intl units; 750000 intl units.

Streptokinase is available in a dosage form, such as an injection.

Streptokinase is approved for the treatment of Myocardial Infarction:

Consume a diet high in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, non-tropical oils, and nuts, and reduce your intake of sweets, sugar-added beverages, and red meats. Limit saturated fat to 5-6% of calories. Reduce trans-fats. Consume no more than 2,400 mg/day of sodium.

Streptokinase may be contraindicated in the following.

Existing or recent internal hemorrhage, intracranial neoplasm or other neoplasms with risk of hemorrhage, arteriovenous malformation or aneurysm, recent CVA, recent head trauma, intracranial or intraspinal surgery, known hemorrhagic 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 postoperative 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).

Avoid taking alcohol with Streptokinase as it may result in side effects like headache, dizziness, and faintness.

Pregnancy

Pregnancy Category C - Animal reproduction studies have not been conducted with Streptokinase. It is also not known whether Streptokinase can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Streptokinase should be given to a pregnant woman only if clearly needed.

Salt Substitutes: Those who are taking Streptokinase should avoid sodium, calcium, and magnesium-rich foods. The salts may reduce the blood-pressure-lowering effect of Streptokinase.

The adverse reactions related to the molecule Streptokinase can be categorized as

• Common Adverse Effects: Coronary thrombolysis; hypotension, tachycardia, and/or bradycardia during initial infusion.
• Less Common Adverse Effects: Injection site bleeding, ecchymoses, chills, fevers, asthenia, and malaise.
• Rare Adverse Effects: Genitourinary bleeding, anaphylactic reactions.

The clinically relevant drug interactions of Streptokinase are briefly summarized here.

Increased risk of hemorrhage with drugs that inhibit platelet function (e.g., platelet aggregation inhibitors, dextrans).

Potentially Fatal: Increased risk of hemorrhage with anticoagulants (e.g. heparin).

Pharmacodynamics:

Streptokinase is a polypeptide derived from beta-hemolytic streptococci of Lancefield group C bacteria. It forms a complex with plasminogen, which then converts to the proteolytic enzyme plasmin. This process results in a cascade that ultimately leads to the lysis of fibrin clots. Streptokinase causes a systemic thrombolytic state that usually resolves within 48 hours of administration. The half-life of Streptokinase is between 23 and 29 minutes; however, it has been reported as high as 89 minutes in some instances.

Pharmacokinetics:

• Metabolism:

Metabolized in the liver via proteolysis.

• Excretion:

Via urine (as peptides). Elimination half-life: 80 minutes (streptokinase-plasminogen activator complex).

1. https://www.mims.com/india/drug/info/Streptokinase ?type=full&mtype=generic
2. https://go.drugbank.com/drugs/DB00590
3. https://www.rxlist.com/consumer_Streptokinase _cardura/drugs-condition.htm