Urokinase

Urokinase is a medicine used to break down harmful blood clots that have formed in the blood vessels. It is used to treat patients who have suffered a recent heart attack. It is also used in treating conditions such as pulmonary embolism and stroke. Urokinase is administered under the supervision of a doctor. Your doctor will decide the dose and duration of the medicine for you. The doctor may closely monitor your condition till you became stable. Use of this medicine may cause nausea, injection site bleeding, allergic reaction, and decrease in blood pressure. It may increase your risk of bleeding also. Your doctor will explain the benefits and risks associated with this medicine before it is administered. You should continue all your other medicines that are advised by the doctor for your long-term treatment even after this injection. This medicine is used with caution for some people. Thus, you must inform the doctor if you are suffering from any bleeding disorder, kidney or liver disease. Also, let your doctor know if you are pregnant or breastfeeding and about all the other medications that you are taking regularly. Urokinase works by dissolving the harmful blood clots in the blood vessels. This restores the blood flow to the affected tissue, thereby preventing tissue death and improving outcomes.

• Heart attack • Pulmonary embolism

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.

Adult Dose: 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. 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. 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. 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. 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. 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.

Your doctor or nurse will give you this medicine. Kindly do not self administer.

If you miss a dose of Urokinase, please consult your doctor.

Common: • Allergic reaction • Nausea • Vomiting • Injection site bleeding

[NOT RELEVANT] Not relevant, as Urokinase is intended for use in hospitalised patients. It increases your risk of bleeding. Be careful while shaving, cutting fingernails or toenails, using sharp objects or engaging in contact sports (e.g. football, wrestling). Do not discontinue use without consulting your doctor as this may increase your chances of having another heart attack or stroke.

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.

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.

[CONSULT YOUR DOCTOR] It is not known whether it is safe to consume alcohol with Urokinase. Please consult your doctor.

[SAFE IF PRESCRIBED] Urokinase is generally considered safe to use during pregnancy. Animal studies have shown low or no adverse effects to the developing baby; however, there are limited human studies.

[SAFE IF PRESCRIBED] Urokinase is probably safe to use during breastfeeding. Limited human data suggests that the drug does not represent any significant risk to the baby.

[SAFE IF PRESCRIBED] Urokinase is probably safe to use in patients with kidney disease. Limited data available suggests that dose adjustment of Urokinase may not be needed in these patients. Please consult your doctor. Use of Urokinase is not recommended in patients with severe kidney disease. [CAUTION] Urokinase should be used with caution in patients with liver disease. Dose adjustment of Urokinase may be needed. Please consult your doctor.