Streptokinase: Medication Information and Guidelines

Medication Information and Guidelines

Streptokinase is a thrombolytic medication used for the treatment of acute myocardial infarction, pulmonary embolism, deep vein thrombosis, and arterial thrombosis. It belongs to the class of medications known as fibrinolytics, which work by promoting the conversion of plasminogen to plasmin, an enzyme that degrades fibrin clots and dissolves thrombi. Streptokinase is derived from beta-hemolytic streptococci and acts as a plasminogen activator, leading to systemic fibrinolysis and restoration of blood flow in occluded vessels.

Recommended Dose and Dosage Regimen

The recommended dose of streptokinase varies depending on the indication, patient’s weight, medical history, and the specific thrombotic event being treated. For the management of acute myocardial infarction, the typical dose is 1.5 million units administered intravenously over 30-60 minutes, followed by continuous intravenous infusion of heparin to maintain anticoagulation. The dose may be adjusted based on the patient’s clinical response, with careful monitoring of vital signs, electrocardiographic changes, and laboratory parameters. In some cases, additional doses of streptokinase may be administered if reperfusion is not achieved or if there is evidence of recurrent thrombosis.

Frequency of Administration

Streptokinase is administered as a single intravenous infusion over 30-60 minutes to initiate fibrinolysis and dissolve thrombi in occluded vessels. The frequency of administration depends on the patient’s response to therapy, the severity of the thrombotic event, and the presence of contraindications or complications. Continuous monitoring of vital signs, electrocardiographic changes, and laboratory parameters is essential during and after streptokinase therapy to assess treatment efficacy, detect adverse reactions, and manage complications such as bleeding or allergic reactions.

Route of Administration

Streptokinase is administered intravenously as a sterile lyophilized powder for reconstitution in a compatible intravenous fluid, such as normal saline or dextrose solution. The reconstituted solution should be prepared according to the manufacturer’s instructions and administered using a calibrated infusion pump to ensure accurate dosing and infusion rate. Streptokinase should not be mixed or diluted with other medications or solutions in the same infusion line, as this may lead to incompatibilities or loss of efficacy. The infusion should be administered by trained healthcare personnel in a controlled clinical setting equipped to manage thrombolytic emergencies and monitor patient response.

Mechanism of Action (MOA)

Streptokinase acts as a plasminogen activator by binding to plasminogen in the circulation and converting it to plasmin, an enzyme that degrades fibrin clots and dissolves thrombi. Plasmin cleaves the cross-linked fibrin meshwork of thrombi, leading to fibrinolysis and restoration of blood flow in occluded vessels. Streptokinase has broad specificity for plasminogen and can activate both circulating and bound forms of the proenzyme, resulting in systemic fibrinolysis and dissolution of thrombi at the site of vascular occlusion. Streptokinase-mediated fibrinolysis helps prevent tissue ischemia, reduce infarct size, and improve clinical outcomes in patients with acute thrombotic events.

Pharmacokinetics (PK)

Streptokinase is administered intravenously and rapidly distributed throughout the systemic circulation, where it binds to plasminogen and initiates fibrinolysis at the site of thrombus formation. It has a short half-life of approximately 20-30 minutes and is rapidly cleared from the circulation by hepatic metabolism and renal excretion. The pharmacokinetics of streptokinase may be affected by factors such as patient age, renal function, and concomitant use of medications that affect fibrinolysis or coagulation. Close monitoring of vital signs, electrocardiographic changes, and laboratory parameters is necessary during and after streptokinase therapy to assess treatment efficacy and detect adverse reactions or complications.

Pharmacodynamics (PD)

Streptokinase exerts its pharmacodynamic effects by promoting the conversion of plasminogen to plasmin, an enzyme that degrades fibrin clots and dissolves thrombi. Plasmin cleaves the cross-linked fibrin meshwork of thrombi, leading to fibrinolysis and restoration of blood flow in occluded vessels. Streptokinase has broad specificity for plasminogen and can activate both circulating and bound forms of the proenzyme, resulting in systemic fibrinolysis and dissolution of thrombi at the site of vascular occlusion. Streptokinase-mediated fibrinolysis helps prevent tissue ischemia, reduce infarct size, and improve clinical outcomes in patients with acute thrombotic events.

Pathophysiology

Acute thrombotic events such as myocardial infarction, pulmonary embolism, deep vein thrombosis, and arterial thrombosis are characterized by the formation of blood clots or thrombi in the circulation, leading to vascular occlusion and tissue ischemia. These conditions may be caused by a variety of factors, including atherosclerosis, platelet activation, endothelial injury, hypercoagulable states, or venous stasis. Streptokinase is used as a thrombolytic agent to dissolve thrombi and restore blood flow in occluded vessels, thereby preventing tissue necrosis, reducing infarct size, and improving clinical outcomes in affected patients.

Primary Indications

Streptokinase is indicated for the treatment of acute myocardial infarction, pulmonary embolism, deep vein thrombosis, and arterial thrombosis. It is commonly used in emergency medicine and critical care settings to initiate fibrinolysis and dissolve thrombi in occluded vessels, thereby restoring blood flow and preventing tissue ischemia. Streptokinase therapy is initiated promptly upon diagnosis of a thrombotic event and may be continued for several hours or days, depending on the patient’s clinical response, the severity of the thrombosis, and the presence of contraindications or complications.

Contraindications

Contraindications to streptokinase therapy include hypersensitivity to streptokinase or any component of the formulation, active bleeding or hemorrhagic diathesis, recent trauma or surgery, intracranial hemorrhage or stroke, severe uncontrolled hypertension, aortic dissection, infective endocarditis, or known bleeding disorders such as hemophilia or von Willebrand disease. Streptokinase should be used with caution in patients with conditions that may increase the risk of bleeding or hemorrhage, such as peptic ulcer disease, liver disease, or renal impairment. Close monitoring of vital signs, laboratory parameters, and signs of bleeding is essential during streptokinase therapy to detect adverse reactions or complications promptly.

Purpose of Taking Medication

The purpose of streptokinase therapy is to initiate fibrinolysis and dissolve thrombi in occluded vessels, thereby restoring blood flow and preventing tissue ischemia in patients with acute thrombotic events such as myocardial infarction, pulmonary embolism, deep vein thrombosis, or arterial thrombosis. Streptokinase is used as a thrombolytic agent to improve clinical outcomes, reduce infarct size, and prevent complications associated with vascular occlusion, such as tissue necrosis, organ dysfunction, or death. Streptokinase therapy is initiated promptly upon diagnosis of a thrombotic event and may be continued for several hours or days, depending on the patient’s response to therapy and the severity of the thrombosis.

Usage Instructions

Streptokinase should be administered intravenously as a single infusion over 30-60 minutes to initiate fibrinolysis and dissolve thrombi in occluded vessels. The dose and duration of therapy depend on the patient’s weight, medical history, and the specific thrombotic event being treated. Streptokinase should be administered by trained healthcare personnel in a controlled clinical setting equipped to manage thrombolytic emergencies and monitor patient response. Continuous monitoring of vital signs, electrocardiographic changes, and laboratory parameters is necessary during and after streptokinase therapy to assess treatment efficacy, detect adverse reactions, and manage complications such as bleeding or allergic reactions.

Precautions and Care

Patients receiving streptokinase therapy should be closely monitored for signs and symptoms of adverse reactions, including bleeding, allergic reactions, hypotension, and dysrhythmias. Baseline assessments of coagulation parameters, renal function, and hepatic function may be indicated before initiating therapy. Streptokinase should be used with caution in patients with conditions that may increase the risk of bleeding or hemorrhage, such as peptic ulcer disease, liver disease, or renal impairment. Close communication between patients, caregivers, and healthcare providers is essential to optimize treatment outcomes and ensure safe and effective use of streptokinase.

Dietary Considerations

There are no specific dietary restrictions associated with streptokinase use. However, patients should maintain a balanced diet and adequate hydration to support overall health and mitigate potential side effects such as hypotension or electrolyte imbalances. Patients should avoid consuming excessive amounts of alcohol or caffeine, as these substances may exacerbate adverse effects or interfere with the pharmacological effects of streptokinase. Patients should consult with a registered dietitian or pharmacist for personalized dietary recommendations based on their medical history, treatment regimen, and nutritional needs.

Possible Side Effects

Common side effects of streptokinase may include bleeding or hemorrhage at the site of vascular access, gastrointestinal bleeding, ecchymosis, petechiae, hematuria, epistaxis, or gingival bleeding. Other common side effects may include allergic reactions such as rash, urticaria, angioedema, or anaphylaxis. Serious adverse reactions such as intracranial hemorrhage, retroperitoneal bleeding, or cardiac dysrhythmias may occur rarely and require immediate medical attention. Patients should be advised to report any new or worsening symptoms to their healthcare provider promptly. Healthcare providers should monitor for signs of adverse reactions or complications during therapy and implement appropriate interventions as needed.

Storage and Disposal

Streptokinase powder for reconstitution should be stored at room temperature away from light and moisture. Reconstituted solutions should be used immediately or within the specified time frame according to the manufacturer’s instructions. Unused or expired medication should be discarded properly according to local regulations or guidelines for pharmaceutical waste disposal. Patients should not save leftover medication for future use or share it with others, as this may lead to inappropriate use and the development of medication-related adverse effects. Healthcare providers should educate patients and caregivers on safe medication storage and disposal practices to prevent accidental ingestion or environmental contamination.

Overdose or Emergency

In case of streptokinase overdose or emergency, seek immediate medical attention or contact a poison control center. Overdose may lead to excessive fibrinolysis, bleeding, or hemorrhage, and requires prompt intervention to prevent complications. Treatment of streptokinase overdose may involve discontinuation of the infusion, supportive care, administration of blood products or coagulation factors, and monitoring of vital signs and laboratory parameters. Healthcare providers should be prepared to administer appropriate interventions and manage complications associated with streptokinase toxicity or overdose.

Important Note: Always consult with a healthcare professional for personalized medical advice and guidance regarding the use of given drug, especially regarding dosing, administration, and potential side effects. Your healthcare provider can provide tailored recommendations based on your individual medical history, current medications, and specific treatment needs. Never self-adjust your given drug regimen or discontinue treatment without first consulting your healthcare provider. If you have any questions or concerns about given drug or its use, talk to your doctor or pharmacist for further information and assistance.