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urokinase

Generic Name: urokinase (URE oh KYE nase)
Brand Name: Kinlytic, Abbokinase, Abbokinase Open-Cath

What is urokinase?

Urokinase is a man-made product developed using a protein that occurs naturally in the kidneys. Urokinase is a thrombolytic agent that works by dissolving blood clots.

Urokinase is used to treat blood clots in the lungs.

Urokinase may also be used for purposes not listed in this medication guide.

What is the most important information I should know about urokinase?

You should not use this medication if you have internal bleeding, a brain tumor or aneurysm, hemophilia or other bleeding disorder, arterial hypertension, or if you have recently had a stroke, brain or spinal surgery, or medical emergency requiring CPR (cardiopulmonary resuscitation).

What should I discuss with my health care provider before I receive urokinase?

You should not use this medication if you are allergic to urokinase, or if you have:

  • internal bleeding;

  • a brain tumor;

  • a brain aneurysm (dilated blood vessel);

  • a bleeding or blood clotting disorder (such as hemophilia);

  • a condition called arterial hypertension;

  • if you have had a recent medical emergency requiring CPR (cardiopulmonary resuscitation);

  • if you have had a stroke, brain surgery, or spinal surgery within in the past 2 months.

To make sure urokinase is safe for you, tell your doctor if you have:

  • a history of stroke;

  • severe liver or kidney disease;

  • eye problems caused by diabetes;

  • an infection of the lining of your heart (also called bacterial endocarditis);

  • a blood clot of your heart;

  • a recent history of stomach or intestinal bleeding;

  • if you are pregnant or have had a baby within the past 10 days; or

  • if you have had surgery or an organ transplant within the past 10 days.

FDA pregnancy category B. Urokinase is not expected to be harmful to an unborn baby. However, your doctor should know if you are pregnant before you receive this medication.

It is not known whether urokinase passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Urokinase is made from human kidney cells and albumin (part of the blood) which may contain viruses and other infectious agents. Donated plasma is tested and treated to reduce the risk of it containing infectious agents, but there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.

How is urokinase given?

Urokinase is given as an injection through a needle placed into a vein. You will receive this injection in a clinic or hospital setting.

Urokinase is given slowly, usually over a period of 12 hours, using a continuous infusion pump.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving urokinase.

What happens if I miss a dose?

Because you will receive urokinase in a clinical setting, you are not likely to miss a dose.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid while receiving urokinase?

Avoid taking aspirin or ibuprofen (Motrin, Advil) to treat a fever shortly after you have received urokinase. These medications can increase your risk of bleeding. Ask your doctor about other methods of treating a fever.

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Urokinase side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Urokinase increases your risk of bleeding, which can be severe or life-threatening. Call your doctor or seek emergency medical attention if you have bleeding that will not stop. Bleeding may occur from a surgical incision, or from the skin where a needle was inserted during a blood test or while receiving injectable medication. You may also have bleeding on the inside of your body, such as in your stomach or intestines, kidneys or bladder, brain, or within the muscles.

Call your doctor at once if you have signs of bleeding inside your body, such as:

  • easy bruising or bleeding (nosebleeds, bleeding gums, bleeding from a wound, incision, catheter, or needle injection);

  • bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  • red or pink urine; or

  • sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance.

Also call your doctor at once if you have:

  • chest pain or heavy feeling, pain spreading to the jaw or shoulder, nausea, sweating, general ill feeling;

  • fever, chills, flu symptoms, nausea, vomiting, back pain, or stomach pain;

  • swelling, rapid weight gain, little or no urinating;

  • red or purple discoloration of fingers or toes;

  • weak or shallow breathing, blue-colored lips or fingernails;

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure); or

  • pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Urokinase dosing information

Usual Adult Dose for Myocardial Infarction:

Lysis of coronary artery thrombi:
Prior to beginning urokinase, a bolus of heparin 2500 to 10,000 units IV once should be given. Prior heparin administration should be considered when calculating the heparin dose.

Systemic thrombolytic administration:
1 to 2 million intl units administered IV once over 15 to 30 minutes. The rate of infusion is limited by side effects (fever, chills, rigors), and may need to be decreased in some patients. Doses up to 3 million intl units have been used to treat acute myocardial infarction (AMI).

To determine the response to urokinase, the manufacturer recommends serial angiography every 15 minutes. Maximal coronary artery opening usually occurs 15 to 30 minutes after opening begins.

Direct intracoronary artery infusion:
Following the heparin bolus, urokinase may be infused into the occluded artery at a rate of 6000 intl units/min for up to 2 hours, with an average total dose of 500,000 intl units administered.

Alternatively, some studies have reported administering urokinase infusions at a rate of 20,000 to 25,000 intl units/min for 10 to 20 minutes up to a total dose of 250,000 to 500,000 intl units. It has not been established that intracoronary administration of urokinase during evolving transmural AMI results in salvage of myocardial tissue, nor that it reduces mortality.

Heparin therapy (without a loading dose) is recommended when the thrombin time has decreased to less than twice the normal control value.

Usual Adult Dose for Pulmonary Embolism:

Initial: 4400 intl units/kg ideal body weight (IBW) administered as an IV bolus over 10 minutes.

Maintenance: 4400 intl units/kg (IBW) /hour administered as a continuous IV infusion for 12 hours.

Heparin therapy (without a loading dose) is recommended when the thrombin time has decreased to less than twice the normal control value.

Usual Adult Dose for Deep Vein Thrombosis:

Initial: 4400 intl units/kg ideal body weight (IBW) administered as an IV bolus over 10 minutes.

Maintenance: 4400 intl units/kg (IBW) /hour administered as a continuous IV infusion for 72 hours. Treatment may be needed for as long as 10 to 14 days in selected patients.

Heparin therapy (without a loading dose) is recommended when the thrombin time has decreased to less than twice the normal control value.

Usual Adult Dose for Thrombotic/Thromboembolic Disorder:

IV catheter clearance:
When the following procedure is used for thrombolysis of a central venous catheter, the patient should be asked to hold his/her breath at end-exhalation any time the catheter is not connected to IV tubing, a heparin lock, or a syringe (to avoid air embolism).

Once a clot is suspected (after gentle aspiration of the affected catheter with a 10 mL syringe), 5000 intl units urokinase in a 1 mL tuberculin syringe may be slowly and gently injected, using only an amount equivalent to the volume of the catheter. A 5 or 10 mL syringe may be used to gently aspirate from the catheter every 5 minutes. If the catheter is not open within 30 minutes, the catheter may be capped allowing urokinase to dwell inside for 30 to 60 minutes before again attempting to aspirate. A second injection may be necessary in resistant cases.

Once patency is restored, aspiration and removal of 5 mL of blood is recommended to remove all drug and clot residual. Flushing the catheter with normal saline injection is then recommended.

What other drugs will affect urokinase?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with urokinase, especially:

  • NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or

  • medication used to prevent blood clots--dabigatran, dalteparin, desirudin, enoxaparin, fondaparinux, tinzaparin, warfarin, Coumadin.

This list is not complete. Other drugs may interact with urokinase, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about urokinase.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.02. Revision Date: 2014-04-13, 8:32:56 PM.

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