Urokinase

Generic name
Urokinase
Brand name
ATC Code
B01AD04
Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

No information

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Thrombolytic treatment of occluded central venous access devices (CVAD)
  • Route of administration not applicable
    • 1 month up to 18 years
      • 7.500 - 10.000 IU/dose, once only in 2 ml physiological saline. Try to inject the line to clear it after 5 to 10 min; repeat the procedure if that does not work. Heparin (5 IU/kg/hour) is then added to the infusion liquid for 12 hours to prevent it occluding again..
Thrombolysis
  • Intravenous
    • 0 years up to 18 years
      • Initial dose: 4.400 IU/kg/dose, bolus.
      • Maintenance dose: 4.400 IU/kg/hour, continuous infusion for 6-12 hours.

      • Thrombolysis should only be applied in cases where there is a life-threatening thrombus or a thrombus that threatens a limb or organ.

        Treatment by or after consultations with a paediatric specialist (haematologist) who has experience using urokinase for this indication.

Renal impaiment in children > 3 months

GFR ≥10 ml/min/1.73m2: Dose adjustment not required.

GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects

No information is present at this moment.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications in children

Watch out for an increased tendency to bleed: biopsies and surgery are contraindicated where urokinase is having a systemic effect.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Strictly on indication: only use after consulting a haematologist.

Administration: preferably via catheter where the thrombus is located. Do not give heparin during thrombolysis
Checks prior to treatment: Lab checks: aPTT, PT, VBB, d-dimer, fibrinogen. In neonates: ultrasound of the cerebrum

Conditions for treatment with urokinase:
Thrombocytes > 50-100 x10e9/litre in sick patients
Thrombocytes > 50 x10e9/litre in stable patients
Fibrinogen > 1.0 mg/l
Normal or minimally extended PT and aPTT

If the thrombocyte count is low: thrombocyte transfusion
If the fibrinogen concentration is low: plasma transfusion

In cases of severe bleeding, tranexamic acid (Cyclokapron) can be given as an antidote. Risk factors include recent bleeding, surgery, peptic ulcer, ulcerative colitis.
 

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

ANTITHROMBOTIC AGENTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Vitamin K antagonists
B01AA07
B01AA04
Heparin group
B01AB04
B01AB09
B01AB05
B01AB01
B01AB06
B01AB10
Platelet aggregation inhibitors excl. heparin
B01AC06
B01AC04
B01AC09
Enzymes
B01AD02
B01AD01
Direct thrombin inhibitors
B01AE07
Direct factor Xa inhibitors
B01AF02
B01AF01

References

  1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
  2. CBO, Richtlijn Diagnostiek, preventie en behandeling van veneuze trombo-embolie en secundaire preventie van arteriele trombose, www.cbo.nl, 2009, 162
  3. Kamps WA et al, Werkboek ondersteundende behandeling kinderoncologie, VU Uitgeverij, 2005
  4. NVK, Werkboek kinderhematologie, www.hematologienederland.nl, 30 sept 2012

Changes

Therapeutic Drug Monitoring


Overdose