Formulary
Urokinase: 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.
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Urokinase: 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
**Occluded arteriovenous shunts, catheters, and indwelling central lines for urokinase**
- **Neonate** (To the device as a flush): 5000-25 000 units, instil directly into occluded catheter or central line only, dilute dose in Sodium Chloride 0.9% to fill catheter dead space. Leave for 20-60 minutes then aspirate the lysate and flush with Sodium Chloride 0.9%.
- **Child** (To the device as a flush): 5000-25 000 units, instil directly into occluded catheter or central line only, dilute dose in Sodium Chloride 0.9% to fill catheter dead space. Leave for 20-60 minutes then aspirate the lysate and flush with Sodium Chloride 0.9%.
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 urokinase Cavernous pulmonary disease
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 urokinase Common or very common Artery dissection; embolism and thrombosis; stroke Uncommon Renal failure Rare or very rare Vascular pseudoaneurysm
Interactions
**Other interactions (5):**
- Loss of activity of urokinase has been noted when dissolved in 5% glucose at a concentration of 1,500 IU/ml and stored in PVC containers (see section 6.2).
- No information is available regarding other dilutions of urokinase.
- Anticoagulants Concurrent administration of oral anticoagulants or heparin may increase the risk of haemorrhage.
- Medicinal products affecting platelet function Concurrent administration of substances that affect platelet function (e.g.
- Therefore, concomitant administration of urokinase with ACE inhibitors may increase the risk of angioedema.
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.
Breast feeding
Manufacturer advises avoid-no information available.
Hepatic impairment
Manufacturers advise avoid in severe impairment. Hepatic impairment For urokinase Manufacturer advises caution in mild to moderate impairment. Dose adjustments Manufacturer advises consider dose reduction in mild to moderate impairment.
Renal impairment
Caution in mild to moderate impairment (fibrinogen level should not fall below 100 mg/dL); avoid in severe impairment. M Dose adjustments Consider dose reduction in mild to moderate impairment. M
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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