Description of the active substance:
This information is a reference and it is not enough that the drug has been prescribed by a doctor ..
PHARMACHOLOGIC EFFECT
Fibrinolytic agent. It is a protein with a molecular mass of about 50,000 daltons, produced by certain strains of streptococcus. When combined with plasminogen, streptokinase forms a complex that activates the transfer of blood plasma or blood clot into the plasmin (fibrinolysin) - a proteolytic enzyme that dissolves fibrin fibers in blood clots and thrombi, causing degradation of fibrinogen and plasma proteins, including. coagulation factors V and VII.
Since streptokinase is a weak streptococcal antigen, with its intravenous administration neutralization with circulating antibodies is possible; in this regard, the state of fibrinolysis is achieved by the administration of an excessive amount of streptokinase necessary for neutralizing antibodies.
With IV infusion reduces blood pressure and OPSS with a subsequent decrease in the minute volume of blood, in patients with chronic heart failure improves the function of the left ventricle. Reduces the frequency of deaths with myocardial infarction. It improves the functional parameters of the heart. Reduces the number of thrombotic complications in diseases of the cardiovascular system and deaths from pulmonary embolism. The maximum effect is observed after 45 minutes. After the infusion is over, the fibrinolytic effect is observed for several hours, the elongation of the thrombin time persists to 24 hours due to a simultaneous decrease in fibrinogen and an increase in the number of circulating degradation products of fibrin and fibrinogen. Activates not only tissue fibrinolysis (the action is aimed at dissolving thrombus-thrombolysis), but systemic fibrinolysis (cleavage of the fibrinogen of the blood), in connection with this, bleeding may develop (due to hypofibrinogenemia). The most effective for fresh clots of fibrin (before retraction). With intracoronary injection, thrombolysis occurs after 1 hour.
PHARMACOKINETICS
The initial T 1/2 is 13-23 min, the final - 83 min. Streptokinase is not metabolized.
INDICATIONS
Acute myocardial infarction (up to 24 h), thromboembolism of the pulmonary artery and its branches. Thrombosis and thromboembolism of the arteries (acute, subacute, chronic thrombosis of peripheral arteries, chronic obliterating endarteritis, obliteration of the arteriovenous shunt), occlusion of central retinal vessels with antiquity less than 6-8 hours (arteries), less than 10 days (veins); thrombosis of arteries due to diagnostic or therapeutic procedures in children, vascular thrombosis during catheterization in newborns. Thrombosis of veins of internal organs, deep vein thrombosis of limbs (prescription less than 14 days) and pelvis. Retrombosis after operations on the vessels. Thrombosis of hemodialysis shunt. Thrombosis with prosthetic heart valves. Flushing in / in the catheters (including for hemodialysis).Mono- or combined therapy of rest stenocardia with acute myocardial infarction.
DOSING MODE
Individual, depending on the indications and the clinical situation.
SIDE EFFECT
From the coagulation system of the blood: bleeding from the injection site, gums; hemorrhages in the skin, peri- and myocardium, in the brain, hematoma; internal bleeding (including from the digestive tract, urogenital, retroperitoneal).
From the cardiovascular system: reperfusion arrhythmia, non-cardiogenic pulmonary edema (with intracoronary administration), thromboembolism (due to thrombus mobilization or its fragmentation), incl. pulmonary artery (with deep vein thrombosis), distal artery (cholesterol embolus with local thrombolysis), embolic stroke;capillarotoxicosis (Schönlein-Henoch syndrome); an increase in ESR.
Allergic reactions: mainly with repeated injections - skin hyperemia, urticaria, generalized exanthema, dyspnoea, bronchospasm, hyperthermia, chills, headache, myalgia, pain in the spine, lowering blood pressure, brady or tachycardia, arthritis, vasculitis (including hemorrhagic), nephritis, polyneuropathy, angioedema, anaphylactic shock.
On the part of laboratory indicators: with repeated administration, an increase in the activity of hepatic transaminases and alkaline phosphatase, GGT, and CKF;hyperbilirubinemia, decreased cholinesterase activity.
Other: rupture of the spleen.
CONTRAINDICATIONS
Bleeding, hemorrhagic diathesis, erosive and ulcerative lesions of the gastrointestinal tract, inflammatory diseases of the colon, recent multiple injuries, aneurysm, tumors with a tendency to bleeding, brain tumors or metastases in the CNS, arterial hypertension (blood pressure more than 200/110 mmHg) , diabetic retinopathy, acute pancreatitis, endocarditis, pericarditis, mitral heart defects with atrial fibrillation, tuberculosis (active form), pulmonary caverns, sepsis, septic thrombosis, postoperative period (8-12 postoperative days, 3-6 not Delay after extensive surgical interventions, 8 weeks after neurosurgical operations), recent biopsy of internal organs, 4 weeks after translumbral arteriography, 3 months after acute hemorrhagic stroke; the first 18 weeks of pregnancy; pregnancy pathology associated with an increased risk of bleeding, recent childbirth (within 10 days) or abortion; permanent bladder catheter, increased sensitivity to streptokinase.
PREGNANCY AND LACTATION
Streptokinase is contraindicated in pregnancy (especially during the first 18 weeks) and in the postpartum period.
APPLICATION FOR FUNCTIONS OF THE LIVER
Use with caution in renal failure.
APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Use with caution in hepatic and / or renal failure.
APPLICATION IN ELDERLY PATIENTS
Use with caution in elderly patients (over 75 years of age).
SPECIAL INSTRUCTIONS
Use with caution in case of hepatic and / or renal failure, bronchial asthma, streptococcal infection (including rheumatism), bronchiectasis with hemoptysis, with esophageal veins, recent treatment with anticoagulants, condition after cardiopulmonary resuscitation (including indirect massage heart), ventilator, nephrourolythiasis, with menorrhagia, menstruation, in the case of prior treatment with streptokinase (from 5 days to 1 year), in elderly patients (over 75 years old).
In the case of local thrombolysis in the peripheral arteries, one should bear in mind the risk of embolism with cholesterol in the distal artery.
The use of heparin is possible after 4 hours after stopping the infusion of streptokinase.
DRUG INTERACTION
When used simultaneously with heparin, coumarin derivatives, dipyridamole, dextrans, acetylsalicylic acid, the action of streptokinase is potentiated.
