urokinase
Abbokinase, Abbokinase Open-Cath

Available forms
Available by prescription only
Injection: 5,000 IU/ml unit-dose vial; 250,000-IU/vial

Indications and dosages
 Lysis of acute massive pulmonary emboli and of pulmonary emboli accompanied by unstable hemodynamics. Adults: For I.V. infusion only by constant infusion pump; priming dose: 4,400 IU/kg over 10 minutes, followed by 4,400 IU/kg hourly for 12 hours.
 Coronary artery thrombosis. Adults: 6,000 IU/ minute of urokinase intra-arterial via a coronary artery catheter until artery is maximally opened, usually within 15 to 30 minutes; however, drug has been administered for up to 2 hours. Average total dose, 500,000 IU.
 Venous catheter occlusion. Adults: Instill 5,000 IU into occluded line.

Pharmacodynamics
Thrombolytic action: Urokinase promotes thrombolysis by directly activating conversion of plasminogen to plasmin.

Pharmacokinetics
Absorption: Administered I.V.
Distribution: Rapidly cleared from circulation; most drug accumulates in the kidneys and liver.
Metabolism: Rapidly metabolized by the liver.
Excretion: Small amount is eliminated in urine and bile. Half-life is 10 to 20 minutes; longer in patients with hepatic dysfunction.

Contraindications and precautions
Contraindicated in patients with active internal bleeding, history of CVA, aneurysm, arteriovenous malformation, known bleeding diathesis, recent trauma with possible internal injuries, visceral or intracranial malignancy, ulcerative colitis, diverticulitis, severe hypertension, hemostatic defects including those resulting from severe hepatic or renal insufficiency, uncontrolled hypocoagulation, chronic pulmonary disease with cavitation, subacute bacterial endocarditis or rheumatic valvular disease, and recent cerebral embolism, thrombosis, or hemorrhage.
  Also contraindicated during pregnancy and first 10 days postpartum, within 10 days after intra-arterial diagnostic procedure or surgery (including liver or kidney biopsy, lumbar puncture, thoracentesis, paracentesis, or extensive or multiple cutdowns), or within 2 months after intracranial or intraspinal surgery.
 I.M. injections and other invasive procedures are contraindicated during urokinase therapy.

Interactions
Drug-drug. Aminocaproic acid: Inhibits urokinase-induced activation of plasminogen. Avoid use together.
Anticoagulants, including heparin and oral anticoagulants: Causes hemorrhage. Heparin must be stopped and its effects allowed to diminish. It may also be necessary to reverse effects of oral anticoagulants before beginning therapy.
Aspirin, indomethacin, phenylbutazone, other drugs that affect platelet activity: Increases risk of bleeding. Avoid use together.

Adverse reactions
CNS: fever.
CV: reperfusion arrhythmias, tachycardia, transient hypotension or hypertension.
GI: nausea, vomiting.
Hematologic: bleeding.
Respiratory: bronchospasm, minor breathing difficulties.
Skin: rash, phlebitis at injection site.
Other: anaphylaxis, chills.

Effects on lab test results
• May increase PT, PTT, and INR. May decrease hematocrit.

Overdose and treatment
Signs and symptoms of overdose reflect potentially serious bleeding: bleeding gums, epistaxis, hematoma, spontaneous ecchymoses, oozing at catheter site, increased pulse, and pain from internal bleeding.
 Discontinue drug and restart when bleeding stops.

Special considerations
 ALERT Prescribing, dispensing, and dosing errors have been reported using the abbreviation IU. Take care to write clearly or spell out if possible.
• Don’t use bacteriostatic water to reconstitute.
• Product contains no preservatives; discard unused portion.
• Drug may affect platelet function.
• Monitor patient for signs of hemorrhage.
Pregnant patients
• There are no adequate or controlled studies using urokinase in pregnant women. Don’t use drug during pregnancy unless clearly needed.
Breast-feeding patients
• It isn’t known if drug appears in breast milk. Use cautiously in breast-feeding women.
Pediatric patients
• Safety and efficacy in children haven’t been established.
Geriatric patients
• Patients age 75 and older have a greater risk of cerebral hemorrhage because they’re more apt to have cerebrovascular disease.

Patient education
• Explain use and administration of urokinase to patient and family.
• Instruct patient to report adverse reactions promptly.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use