Urokinase

Generic name: urokinase (URE oh KYE nase)
Brand name: Kinlytic, Abbokinase, Abbokinase Open-Cath
Dosage forms: intravenous powder for injection (250000 intl units)
Drug class: Thrombolytics

Urokinase is a thrombolytic (THROM-bo-LIT-ik) drug, sometimes called a "clot-busting" drug. It helps your body produce a substance that dissolves unwanted blood clots.

Urokinase is used to treat blood clots in the lungs.

Urokinase may also be used for purposes not listed in this medication guide.

Warnings

If possible before you receive urokinase, tell your doctor if you have a brain tumor or aneurysm, hemophilia or other bleeding disorder, high blood pressure, or if you have recently had a stroke, brain or spinal surgery, or medical emergency requiring CPR (cardiopulmonary resuscitation).

In an emergency situation it may not be possible to tell your caregivers about your health conditions. Make sure any doctor caring for you afterward knows you have received urokinase.

Before taking this medicine

You should not be treated with urokinase if you are allergic to it, or if you have:

• active bleeding inside your body;
• a brain tumor or blood vessel disorder;
• a brain aneurysm (dilated blood vessel);
• a bleeding or blood clotting disorder (such as hemophilia);
• severe or uncontrolled high blood pressure;
• if you have had a recent medical emergency requiring CPR (cardiopulmonary resuscitation); or
• if you have had a stroke, brain surgery, or spinal surgery within in the past 2 months.

If possible before you receive urokinase, tell your doctor if you have:

• a history of stroke;
• severe liver or kidney disease;
• eye problems caused by diabetes;
• an infection of the lining of your heart (also called bacterial endocarditis);
• a blood clot of your heart;
• a recent history of stomach or intestinal bleeding;
• if you are pregnant or have had a baby within the past 10 days; or
• if you have had surgery or an organ transplant within the past 10 days.

In an emergency situation it may not be possible to tell your caregivers if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medicine.

Urokinase is made from human plasma (part of the blood) which may contain viruses and other infectious agents. Donated plasma is tested and treated to reduce the risk of it containing infectious agents, but there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.

How is urokinase given?

Urokinase is injected into a vein through an IV. A healthcare provider will give you this injection.

Urokinase is given slowly, usually over a period of 12 hours, using a continuous infusion pump.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving urokinase.

After treatment with urokinase, your doctor may prescribe a blood thinner or other medication to help prevent future blood clots. Carefully follow all dosing instructions. These medications can make it easier for you to bleed, even from a minor injury.

What happens if I miss a dose?

Because you will receive urokinase in a clinical setting, you are not likely to miss a dose.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid while receiving urokinase?

Ask your doctor before taking aspirin or ibuprofen (Motrin, Advil) shortly after you have received urokinase. These medications can increase your risk of bleeding.

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Urokinase side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Urokinase increases your risk of bleeding, which can be severe or life-threatening. Call your doctor or seek emergency medical attention if you have bleeding that will not stop. Bleeding may occur from a surgical incision, or from the skin where a needle was inserted during a blood test or while receiving injectable medication. You may also have bleeding on the inside of your body, such as in your stomach or intestines, kidneys or bladder, brain, or within the muscles.

Call your doctor at once if you have signs of bleeding inside your body, such as:

• easy bruising or bleeding (nosebleeds, bleeding gums, bleeding from a wound, incision, catheter, or needle injection);
• bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
• red or pink urine; or
• sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance.

Some side effects may occur during or within 1 hour after the injection. Tell your caregiver right away if you feel chilled or feverish, nauseated, light-headed, or have chest tightness, back pain, trouble breathing, or fast heartbeats.

Also call your doctor at once if you have:

• chest pain or heavy feeling, pain spreading to the jaw or shoulder, nausea, sweating, general ill feeling;
• swelling, rapid weight gain, little or no urinating;
• severe stomach pain, nausea, and vomiting;
• darkening or purple discoloration of your fingers or toes;
• very slow heartbeats, shortness of breath, feeling light-headed;
• sudden severe back pain, muscle weakness, numbness or loss of feeling in your arms or legs;
• dangerously high blood pressure--severe headache, blurred vision, pounding in your neck or ears, nosebleed, anxiety, confusion, severe chest pain, shortness of breath, irregular heartbeats; or
• pancreatitis--severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Urokinase dosing information

Usual Adult Dose for Pulmonary Embolism:

Initial dose: 4400 international units/kg IV at a rate of 90 mL/hr over 10 minutes

Maintenance dose: 4400 international units/kg/hr IV at a rate of 15 mL for 12 hours

Comments:
-Institute treatment soon after onset of pulmonary embolism to avoid potential decrease in efficacy.
-Administration of this drug may be repeated as necessary.
-After infusing this drug, do not begin anticoagulation until activated partial thromboplastin time (aPTT) has decreased to less than twice the normal control value; if heparin is used, do not administer a loading dose of heparin; treatment should be followed by oral anticoagulants.

Uses:
-Lysis of acute massive pulmonary emboli (obstruction of blood flow to a lobe or multiple segments).
-Lysis of pulmonary emboli accompanied by unstable hemodynamics (e.g., failure to maintain blood pressure without supportive measures).

What other drugs will affect urokinase?

Tell your doctor about all your current medicines and any you start or stop using, especially:

• a blood thinner (heparin, warfarin, Coumadin, Jantoven);
• NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or
• medication used to prevent blood clots--abciximab, eptifibatide, tirofiban, vorapaxar.

This list is not complete. Other drugs may interact with urokinase, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.