Streptase

/ Genmedix

Note: When thrombolytic therapy is necessary or a high antibody concentration against streptokinase is present, or recent streptokinase therapy has been given (more than 5 days and less than one year previously), homologous fibrinolytics should be used Acute transmural myocardial infarction with persistent ST-segment elevation or recent left bundlebranch block.
Systemic administration: In short-term lysis for the treatment of acute myocardial infarction 1.5 Mio IU Streptase are given .within 60 min.
Local administration: In acute myocardial infarction patients are given an intracoronary bolus of 20 000 IU Streptase on .average and a maintenance dose of 2000 IU to 4000 IU per min over 30 to 90 min Acute, subacute and chronic thromboses/embolisms of peripheral venous and arterial vessels :and chronic occlusive arterial diseases.
Systemic administration: In short-term thrombolysis, adults with peripheral venous and arterial vessel occlusions/ embolism receive an initial dose of 250 000 IU Streptase within 30 min, followed by a maintenance dose of 1.5 Mio IU per hour over a maximum of six hours. The six-hour Streptase infusion can be repeated on the following day, depending on the therapeutic success of lysis. However, repetition .of treatment must on no account be conducted later than 5 days after the first course As an alternative to short-term lysis, a long-term lysis for the treatment of peripheral occlusions may be considered. An initial dose of 250 000 IU Streptase is given within 30 min, followed by a maintenance dose of 100 000 IU per hour. The duration of therapy depends on the extension and localisation of the vessel occlusion. In peripheral vessel occlusion the maximum duration is .5 days.
Local administration: Patients with acute, subacute and chronic peripheral thromboses and embolisms receive 1000 IU to 2000 IU Streptase in intervals of 3 to 5 min. The duration of administration depends on the .length and localisation of the vessel occlusion and amounts up to 3 hours at a total dose of max .120 000 IU Streptase .A percutaneous transluminal angioplasty can be performed simultaneously, if necessary.
Occlusions of central retinal artery or vein
Systemic administration: In case of thromboses of the central retinal vessels, lysis of arterial occlusions should be limited to max. 24 hours and in venous occlusions to max. 72 hours. If continuation of thrombolysis ,is indicated due to extensive thrombotic occlusions, therapy should be interrupted for one day .followed by administration of a homologous fibrinolytic.
Dosage for neonates, infants and children: Sufficient experience with Streptase therapy in children is not yet available. The benefit of .treatment has to be evaluated against the potential risks which may aggravate an acute lifethreatening situation.
For full details see prescribing information.

Deep vein thromboses, pulmonary embolism, acute myocardial infarction, acute or subacute thrombosis of peripheral artery, occlusion of central retinal artery/vein, embolism of peripheral artery.

Hypersensitivity, existing or recent internal hemorrhages, all forms of reduced blood coagulability, in particular spontaneous fibrinolysis and extensive clotting disorders. Recent CVA, intracranial or intraspinal surgery. Intracranial neoplasm, recent head trauma, known neoplasm with risk of hemorrhage. Acute pancreatitis, uncontrollable hypertension with systolic values above 200 mm Hg and/or diastolic values above 100 mm Hg or hypertensive retinal changes Grades III/IV.
Pregnancy and lactation: Should only be given during pregnancy after careful consideration of the risks. In the first 18 weeks of pregnancy the use must be restricted to vital indications only. Information on the use during breastfeeding is not available.

Recent severe gastrointestinal bleeding, recent major operations, recent trauma and cardiopulmonary resuscitation. Recent organ biopsy, puncture of non-compressible vessels, intramuscular injections or intubation. Recent delivery, abortion, diseases of the urogenital tract with existing or potential sources of bleeding (indwelling bladder catheter). Septic thrombotic disease, suspicion of severe atherosclerotic vessel degeneration, cerebrovascular diseases, severe diabetes mellitus, diabetic/hemorrhagic retinopathy. Pulmonary diseases with cavitation, severe liver or kidney damages, mitral valve defects or atrial fibrillation. Endocarditis or pericarditis, isolated cases of pericarditis, misdiagnosed as acute myocardial infarction and treated with Streptase have resulted in pericardial effusions including tamponade.
See prescribing information for full details.

If hemorrhages occur premature termination of therapy is not necessary. In severe hemorrhagic complications, therapy is discontinued. Rash, flushing, urticaria, dyspnoea, and bronchospasm may occur.
For full details see prescribing information.

Simultaneous or previous treatment with anticoagulants or substances which act upon the platelet formation or function. The administration of acetylsalicylic acid should commence prior to therapy and be continued for one month.

Due to the risk for the fetus, Streptase should only be given during pregnancy after careful benefit-risk consideration. In the first 18 weeks of pregnancy, the use of streptokinase must be.restricted to vital indications only.
Information on the use of Streptase during breast-feeding is not available