Drug reference

Urokinase

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 170, 171, 172

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Deep-vein thrombosis (thromboembolic occlusive vascular disease) ▶BY INTRAVENOUS INFUSION ▶Adult: Initially 4400 units/kg, to be given over 10–20 minutes, followed by 100 000 units/hour for 2–3 days Pulmonary embolism (thromboembolic occlusive vascular disease) ▶BY INTRAVENOUS INFUSION ▶Adult: Initially 4400 units/kg, to be given over 10–20 minutes, followed by 4400 units/kg/hour for 12 hours Occlusive peripheral arterial disease (thromboembolic occlusive vascular disease) ▶BY INTRA-ARTERIAL INFUSION ▶Adult: (consult product literature) Occluded central venous catheters (blocked by fibrin clots) ▶BY INTRAVENOUS INJECTION ▶Adult: Inject directly into occluded catheter, to be dissolved in sodium chloride 0.9% to a concentration of 5000 units/mL; use a volume sufﬁcient to ﬁll the catheter lumen; leave for 20–60 minutes then aspirate the lysate; repeat if necessary Occluded arteriovenous haemodialysis shunts (blocked by fibrin clots) ▶BY INTRAVENOUS INFUSION, OR BY INTRA-ARTERIAL INFUSION ▶Adult: (consult product literature) SYNER-KINASE ® Deep-vein thrombosis (thromboembolic occlusive vascular disease) ▶BY INTRAVENOUS INFUSION ▶Adult: Initially 4400 units/kg, to be given over 10 minutes, dose to be made up in 15 mL sodium chloride 0.9%, followed by 4400 units/kg/hour for 12–24 hours Pulmonary embolism (thromboembolic occlusive vascular disease) ▶INITIALLY BY INTRAVENOUS INFUSION ▶Adult: Initially 4400 units/kg, to be given over 10 minutes, dose to be made up in 15 mL sodium chloride 0.9%, followed by (by intravenous infusion) 4400 units/kg/hour for 12 hours, alternatively (by intra-arterial injection) initially 15 000 units/kg, to be injected into pulmonary artery, subsequent doses adjusted according to response; maximum 3 doses per day Occlusive peripheral arterial disease ▶BY INTRA-ARTERIAL INFUSION ▶Adult: (consult product literature) Occluded intravenous catheters and cannulas (blocked by fibrin clots) ▶BY INTRA-ARTERIAL INJECTION, OR BY INTRAVENOUS INJECTION ▶Adult: 5000–25 000 units, to be injected directly into catheter or cannula, dose dissolved in suitable volume of sodium chloride 0.9% to ﬁll the catheter or cannula lumen; leave for 20–60 minutes then aspirate the lysate; repeat if necessary

PDF pages 170, 171

Contra Indications

Avoid use within 48 hours postpartum. haemorrhagic stroke. signiﬁcant bleeding

PDF page 171

Cautions

Bacterial endocarditis (use only if warfarin otherwise indicated). conditions in which risk of bleeding is increased. history of gastrointestinal bleeding. hyperthyroidism. hypothyroidism. peptic ulcer. postpartum (delay warfarin until risk of haemorrhage is low—usually 5–7 days after delivery). recent ischaemic stroke. recent surgery. uncontrolled hypertension CAUTIONS, FURTHER INFORMATION ▶Elderly Prescription potentially inappropriate (STOPP Cardiovascular system criteria): . with concurrent signiﬁcant bleeding risk, such as uncontrolled severe hypertension, bleeding diathesis or recent non-trivial spontaneous bleeding (high risk of bleeding) . as part of dual therapy with an antiplatelet agent in patients with stable coronary, cerebrovascular or peripheral arterial disease, without a clear indication for anticoagulant therapy (no added beneﬁt) . for ﬁrst deep venous thrombosis without continuing provoking risk factors (e.g. thrombophilia) for longer than 6 months (no proven added beneﬁt) . for ﬁrst pulmonary embolus without continuing provoking risk factors for longer than 12 months (no proven added beneﬁt) See also Prescribing in the elderly p. 33.

PDF page 171

Safety

Interactions

→Appendix 1: urokinase

PDF page 171

Side Effects

▶Common or very common Artery dissection. embolism and thrombosis. stroke ▶Uncommon Renal failure ▶Rare or very rare Vascular pseudoaneurysm ▶Common or very common Haemorrhage ▶Rare or very rare Alopecia. nausea. vomiting ▶Frequency not known Blue toe syndrome. CNS haemorrhage. diarrhoea. fever. haemothorax. jaundice. pancreatitis. skin necrosis (increased risk in patients with protein C or protein S deﬁciency). skin reactions

PDF page 171

Breast Feeding

Manufacturer advises avoid—no information available.

PDF page 171

Hepatic Impairment

Manufacturer advises caution in mild to moderate impairment. Dose adjustments Manufacturer advises consider dose reduction in mild to moderate impairment. In general, manufacturers advise caution in mild to moderate impairment; avoid in severe impairment.

PDF page 171

Renal Impairment

Dose adjustments Dose reduction may be required.

PDF page 171

Important Safety Information

MHRA/CHM ADVICE: DIRECT-ACTING ANTIVIRALS TO TREAT CHRONIC HEPATITIS C: RISK OF INTERACTION WITH VITAMIN K ANTAGONISTS AND CHANGES IN INR (JANUARY 2017) A EU-wide review has identiﬁed that changes in liver function, secondary to hepatitis C treatment with direct- acting antivirals, may affect the efﬁcacy of vitamin K antagonists; the MHRA has advised that INR should be monitored closely in patients receiving concomitant treatment.

PDF page 171

Conception And Contraception

Women of child- bearing age should be warned of the danger of teratogenicity.

PDF page 171

Pregnancy

Should not be given in the ﬁrst trimester of pregnancy. Warfarin, acenocoumarol, and phenindione cross the placenta with risk of congenital malformations, and placental, fetal, or neonatal haemorrhage, especially during the last few weeks of pregnancy and at delivery. Therefore, if at all possible, they should be avoided in pregnancy, especially in the ﬁrst and third trimesters (difﬁcult decisions may have to be made, particularly in women with prosthetic heart valves, atrial ﬁbrillation, or with a history of recurrent venous thrombosis or pulmonary embolism). Stopping these drugs before the sixth week of gestation may largely avoid the risk of fetal abnormality.

PDF page 171

Monitoring Requirements

▶The base-line prothrombin time should be determined but the initial dose should not be delayed whilst awaiting the result. ▶It is essential that the INR be determined daily or on alternate days in early days of treatment, then at longer intervals (depending on response), then up to every 12 weeks. ▶Change in patient’s clinical condition, particularly associated with liver disease, intercurrent illness, or drug administration, necessitates more frequent testing.

PDF page 171

Dose and formulations

Directions For Administration

For intravenous infusion (Syner-KINASE ®), give continuously or intermittently in Sodium chloride 0.9%.

PDF page 171

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Powder for solution for injection ▶Syner-KINASE (Syner-Med (Pharmaceutical Products) Ltd) Urokinase 10000 unit Syner-KINASE 10,000unit powder for solution for injection vials | 1 vial P £35.95 (Hospital only) Urokinase 25000 unit Syner-KINASE 25,000unit powder for solution for injection vials | 1 vial P £45.95 (Hospital only) Urokinase 100000 unit Syner-KINASE 100,000unit powder for solution for injection vials | 1 vial P £112.95 (Hospital only) Urokinase 250000 unit Syner-KINASE 250,000unit powder for solution for injection vials | 1 vial P s (Hospital only) Urokinase 500000 unit Syner-KINASE 500,000unit powder for solution for injection vials | 1 vial P s (Hospital only) ANTITHROMBOTIC DRUGS › VITAMIN K ANTAGONISTS Vitamin K antagonists f

PDF page 171

Clinical care

Patient And Carer Advice

Anticoagulant treatment booklets should be issued to all patients or their carers; these booklets include advice for patients on anticoagulant treatment, an alert card to be carried by the patient at all times, and a section for recording of INR results and dosage information. In England, Wales, and Northern Ireland, they are available for purchase from: 3M Security Print and Systems Limited Gorse Street, Chadderton Oldham OL9 9QH Tel: 0845 610 1112 GP practices can obtain supplies through their Local Area Team stores. NHS Trusts can order supplies from www.nhsforms.co.uk or by emailing nhsforms@spsl.uk.com. In Scotland, treatment booklets and starter information Cardiovascular system packs can be obtained by emailing stockorders.DPPAS@apsgroup.co.uk or by fax on (0131) 6299 967 Electronic copies of the booklets and further advice are also available at www.npsa.nhs.uk/nrls/alerts-and-directives/ alerts/anticoagulant. eiiii F 149

PDF pages 171, 172

Dose text by age group

Adult

Initially 4400 units/kg, to be given over

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

Initially 4400 units/kg, to be given over

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

(consult product literature)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

Inject directly into occluded catheter, to be

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

(consult product literature)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

Initially 4400 units/kg, to be given over

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

Initially 4400 units/kg, to be given over

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

(consult product literature)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 171

Adult

5000–25 000 units, to be injected directly into

First-line fragment. Read the complete Indications and Dose section above.

PDF page 171

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Urokinase

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 170, 171, 172

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 170, 171

Contra Indications

Avoid use within 48 hours postpartum. haemorrhagic stroke. signiﬁcant bleeding

PDF page 171

Cautions

PDF page 171

Safety

Interactions

→Appendix 1: urokinase

PDF page 171

Side Effects

PDF page 171

Breast Feeding

Manufacturer advises avoid—no information available.

PDF page 171

Hepatic Impairment

PDF page 171

Renal Impairment

Dose adjustments Dose reduction may be required.

PDF page 171

Important Safety Information

PDF page 171

Conception And Contraception

Women of child- bearing age should be warned of the danger of teratogenicity.

PDF page 171

Pregnancy

PDF page 171

Monitoring Requirements

PDF page 171

Dose and formulations

Directions For Administration

For intravenous infusion (Syner-KINASE ®), give continuously or intermittently in Sodium chloride 0.9%.

PDF page 171

Medicinal Forms

PDF page 171

Clinical care

Patient And Carer Advice

PDF pages 171, 172

Dose text by age group

Adult

Initially 4400 units/kg, to be given over

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

Initially 4400 units/kg, to be given over

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

(consult product literature)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

Inject directly into occluded catheter, to be

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

(consult product literature)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

Initially 4400 units/kg, to be given over

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

Initially 4400 units/kg, to be given over

First-line fragment. Read the complete Indications and Dose section above.

PDF page 170

Adult

(consult product literature)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 171

Adult

5000–25 000 units, to be injected directly into

First-line fragment. Read the complete Indications and Dose section above.

PDF page 171

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.