Formulary
Streptokinase: Indications, Dosing, Side Effects and Interactions
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
MedNext Academy | 3 min read
Streptokinase: Indications, Dosing, Side Effects and Interactions
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
Drug action
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
Indications and dose
**Acute myocardial infarction**
- **Adult** (By Intravenous Infusion): 1 500 000 units, to be initiated within 12 hours of symptom onset, dose to be given over 60 minutes.
**Deep-vein thrombosis,Central retinal venous or arterial thrombosis**
- **Adult** (By Intravenous Infusion): 250 000 units, dose to be given over 30 minutes, then 100 000 units every 1 hour for 12 hours for central retinal venous or arterial thrombosis, or for 72 hours for deep-vein thrombosis.
**Pulmonary embolism**
- **Adult** (By Intravenous Infusion): 250 000 units, dose to be given over 30 minutes, then 100 000 units every 1 hour for 24 hours, alternatively 1 500 000 units, dose to be given over 1-2 hours.
**Occlusive peripheral arterial disease**
- **Adult** (By Intravenous Infusion): (consult product literature).
**Intravascular thrombosis for streptokinase**
- **Child 1 month-11 years** (Initially by intravenous infusion): Initially 2500-4000 units/kg, dose to be given over 30 minutes, followed by (by continuous intravenous infusion) 500-1000 units/kg/hour for up to 3 days until reperfusion occurs.
- **Child 12-17 years** (Initially by intravenous infusion): Initially 250 000 units, dose to be given over 30 minutes, followed by (by continuous intravenous infusion) 100 000 units/hour for up to 3 days until reperfusion occurs.
Cautions
Conditions in which thrombolysis might give rise to embolic complications such as enlarged left atrium with atrial fibrillation (risk of dissolution of clot and subsequent embolisation); elderly; external chest compression; hypertension; risk of bleeding (including that from venepuncture or invasive procedures) Cautions For streptokinase Cavernous pulmonary disease; recent streptococcal infections
Contraindications
Acute pancreatitis; aneurysm; aortic dissection; arteriovenous malformation; bacterial endocarditis; bleeding diatheses; coagulation defects; coma; heavy vaginal bleeding; history of cerebrovascular disease (especially recent events or with any residual disability); neoplasm with risk of haemorrhage; oesophageal varices; pericarditis; recent gastro-intestinal ulceration; recent haemorrhage; recent surgery (including dental extraction); recent trauma; severe hypertension
Side effects
Common or very common Anaphylactic reaction; angina pectoris; cardiac arrest; cardiogenic shock; chills; CNS haemorrhage; ecchymosis; fever; haemorrhage; heart failure; ischaemia recurrent (when used in myocardial infarction); nausea; pulmonary oedema; vomiting Uncommon Mitral valve incompetence; reperfusion arrhythmia (when used in myocardial infarction) Rare or very rare Seizure Side-effects, further information Serious bleeding calls for discontinuation of the thrombolytic and may require administration of coagulation factors and antifibrinolytic drugs. Side-effects For streptokinase Common or very common Arrhythmias; asthenia; diarrhoea; epigastric pain; headache; malaise; pain; pericarditis Uncommon Myocardial rupture; pericardial disorders; respiratory arrest; splenic rupture Rare or very rare Arthritis; eye inflammation; hypersensitivity; nephritis; nerve disorders; neurological effects; pulmonary oedema non-cardiogenic (caused by reperfusion); shock; vasculitis
Interactions
**Other interactions (5):**
- Fibrinolytic drugs such as streptokinase and alteplase are contra-indicated in patients receiving Dindevan.
- Interactions to be considered The anticoagulant effect may be potentiated by concomitant administration of the following drugs: allopurinol; anabolic steroids; androgens; anti-arrhythmic...
- These agents include medicinal products such as: - Systemic salicylates, acetylsalicylic acid at anti-inflammatory doses, and NSAIDs including ketorolac, - Other thrombolytics (e.g.
- Anticoagulants, platelet inhibitors, etc: Increased risk of bleeding with oral anticoagulants, epoprostenol, clopidogrel, ticlopidine, streptokinase, dipyridamole, dextran solutions, abciximab,...
- Compatible water-soluble drugs may be infused in Haemaccel, e.g.
Pregnancy
Thrombolytic drugs can possibly lead to premature separation of the placenta in the first 18 weeks of pregnancy. There is also a risk of maternal haemorrhage throughout pregnancy and post-partum, and also a theoretical risk of fetal haemorrhage throughout pregnancy.
Hepatic impairment
Manufacturers advise avoid in severe impairment.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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