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Streptokinase Dosage

Applies to the following strengths: 250000 intl units; 1500000 intl units; 750000 intl units

Usual Adult Dose for Myocardial Infarction

IV infusion: 1.5 million intl units administered IV within a 60 minute period.

Intracoronary infusion: 20,000 intl units administered as an IV bolus, followed by a constant infusion of 2000 intl units/min for 60 minutes resulting in a total dose of 140,000 intl units.

The greatest benefit in mortality reduction has been observed when streptokinase was administered within 1 hour after the onset of symptoms of AMI, although statistically significant benefits were observed when administered up to 6 hours after, and some benefit was observed when administered up to 24 hours after initial onset of symptoms.

Usual Adult Dose for Pulmonary Embolism

250,000 intl units as a bolus infused into a peripheral vein over 30 minutes followed by a maintenance infusion of 100,000 intl units per hour for 24 hours. If a coexisting deep venous thrombus is present or suspected, the infusion should be continued for a total of 72 hours.

Streptokinase treatment should be initiated as soon as possible after thrombotic event onset, preferably within 7 days. The loading dose is recommended to neutralize any anti-streptokinase antibodies which may be present.

If the thrombin time or any other parameter of lysis after four hours is not significantly different from the normal control value, discontinuing streptokinase is recommended because resistance (due to antibodies formed during previous streptococcal exposure) is most likely present.

Usual Adult Dose for Deep Vein Thrombosis

250,000 intl units as a bolus infused into a peripheral vein over 30 minutes followed by a maintenance infusion of 100,000 intl units per hour for 72 hours.

Streptokinase treatment should be initiated as soon as possible after thrombotic event onset, preferably within 7 days. The loading dose is recommended to neutralize any anti-streptokinase antibodies which may be present.

If the thrombin time or any other parameter of lysis after four hours is not significantly different from the normal control value, discontinuing streptokinase is recommended because resistance (due to antibodies formed during previous streptococcal exposure) is most likely present.

Usual Adult Dose for Arterial Thrombosis

250,000 intl units as a bolus infused into a peripheral vein over 30 minutes followed by a maintenance infusion of 100,000 intl units per hour for 24 to 72 hours.

Streptokinase treatment should be initiated as soon as possible after thrombotic event onset, preferably within 7 days. The loading dose is recommended to neutralize any anti-streptokinase antibodies which may be present.

If the thrombin time or any other parameter of lysis after four hours is not significantly different from the normal control value, discontinuing streptokinase is recommended because resistance (due to antibodies formed during previous streptococcal exposure) is most likely present.

Usual Adult Dose for Thrombotic/Thromboembolic Disorder

For occluded arterio-venous cannulae:
250,000 intl units reconstituted in 2 mL of normal saline or D5W solution and introduced slowly into each occluded limb of the cannula. The limbs of the cannula should then be clamped for 2 hours. After treatment, aspirate the contents of the infused cannula limbs, flush with saline, and reconnect the cannula(e).

Streptokinase should be reserved for this use only after an adequate attempt to clear the cannula(e) by gentle syringe aspiration using a heparinized saline solution has been made.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dialysis

Data not available

Other Comments

Streptokinase is no longer manufactured and consequently not available in the U.S. as of 11/30/2005. The information provided applies to when the drug was available.

Because human exposure to streptococci is common, antibodies to streptokinase are prevalent. These antibodies may be present before in streptokinase-naïve patients or may develop 5 days to 12 months after treatment. Because of this, some patients may experience allergic reactions, others may experience less efficacy with the drug, especially if the patient has had prior exposure to streptokinase.

When reconstituting the drug, refrain from shaking the vial because foaming may occur.

Reperfusion arrhythmias during therapy with streptokinase can be a sign of successful coronary thrombolysis. These arrhythmias (e.g., sinus bradycardia, accelerated idioventricular rhythm, ventricular premature repolarizations, ventricular tachycardia) may also be seen during the natural course of acute myocardial infarction, and should be treated with appropriate antiarrhythmic measures. It is recommended that standard antiarrhythmia therapy for bradycardia and/or ventricular irritability be available during streptokinase therapy.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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