Home Drug Guide Urokinase

Drug Guide

Generic Name

Urokinase

Brand Names Kinlytic

Classification

Therapeutic: Thrombolytic agent

Pharmacological: Serine protease

FDA Approved Indications

Pulmonary embolism (PE)
Deep vein thrombosis (DVT)
Acute myocardial infarction (AMI) associated with thrombolysis

Mechanism of Action

Urokinase converts plasminogen to plasmin, leading to fibrin degradation and dissolution of blood clots.

Dosage and Administration

Adult: Initial dose: 4400 IU/kg IV infusion over 10 minutes, followed by continuous infusion of 4400 IU/kg/hour for 12-24 hours, adjusted based on clinical response and bleeding risk.

Pediatric: Data limited; use with caution, dosing similar to adult but adjusted based on weight and clinical judgment.

Geriatric: Adjust dose based on renal function and bleeding risk; careful monitoring required.

Renal Impairment: Use with caution; no specific dose adjustment guidelines available.

Hepatic Impairment: Use with caution; hepatic impairment may affect coagulation status.

Pharmacokinetics

Absorption: Administered intravenously; not applicable for oral absorption.

Distribution: Distributes within plasma and extracellular fluid.

Metabolism: Metabolized by the reticuloendothelial system.

Excretion: Mostly metabolized; unchanged drug not detected in urine.

Half Life: Approximately 15 minutes.

Contraindications

Active bleeding or bleeding diathesis
Recent surgery or trauma
History of stroke or intracranial hemorrhage
Known hypersensitivity to urokinase

Precautions

Monitor closely for signs of bleeding, hypotension, and allergic reactions.
Use with caution in patients with uncontrolled hypertension, recent gastrointestinal bleeding, or severe hypertension.

Adverse Reactions - Common

Bleeding at access site or internally (Common)
Allergic reactions (rash, hypotension, angioedema) (Uncommon)

Adverse Reactions - Serious

Intracranial hemorrhage (Rare; life-threatening)
Anaphylaxis (Rare)

Drug-Drug Interactions

Anticoagulants (warfarin, heparin) increase bleeding risk
Antiplatelet agents (aspirin, clopidogrel)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor coagulation parameters (aPTT, fibrinogen levels), vital signs, and signs of bleeding.

Diagnoses:

Risk for bleeding related to thrombolytic therapy

Implementation: Administer as per protocol, ensure proper IV access, monitor for bleeding and allergic reactions.

Evaluation: Assess for signs of effective thrombolysis and adverse bleeding events.

Patient/Family Teaching

Report any signs of bleeding, dizziness, or severe headache immediately.
Avoid invasive procedures or injections unless directed by healthcare provider.
Inform about the importance of monitoring and follow-up.

Special Considerations

Black Box Warnings:

Major bleeding, including intracranial hemorrhage, can be fatal.

Genetic Factors: No specific genetic considerations.

Lab Test Interference: Can interfere with coagulation tests, leading to false readings.

Overdose Management

Signs/Symptoms: Excessive bleeding, hypotension, shock.

Treatment: Discontinue urokinase, provide supportive care, and manage bleeding with blood products or surgical intervention if necessary.

Storage and Handling

Storage: Store at controlled room temperature (20°C to 25°C). Protect from light.

Stability: Refer to product insert for expiration date and stability after reconstitution.