STABILITY OF STREPTOKINASE INJ

[Nawal Schmitt]

Our nephrologists use inj streptokinase to restore potency to thrombosed haemodialysis catheter

and they dilute one vial of 75000 iu in 100 ml normal saline or water for injection

then use 3 ml only and the remaining is discarded.

My quesions

1- Are you doing same preparations and dilution?

2- If the dilution is ok what is the maximum stability after the reconstitution?

 

I appreciate your help

[Naveed Rivas]

In our hospital, we prepare ALTEPLASE in conc of 2mg/2ml stored in freezer to clear occluded venous catheter. Which is stable for 1 month.

A regimen of alteplase is safe and effective in restoring flow to occluded central venous access devices compared to streptokinase because of the risk of life-threatening anaphylaxis.

[Heather Blois]

we use alteplase to maintain catheter patency. However, I found out an old study with regards of steptokinase use for the same issue, please find it attached with wellness.

Reconstituted Solutions: Streptase reconstituted with 5 mL of saline

(Sodium Chloride Injection USP, 0.9%) or dextrose (Dextrose Injection

USP, 5%) is stable for 24 hours at room temperature (15 to 30°C) and

refrigeration (2 to 4°C).

Hope that helps

[Christian Lancaster]

I’ve always also been through using Alteplase for the purpose of catheter occlusion in HD patients. However, it was an excellent opportunity to revise the use of streptokinase for such purpose.

Kindly find the below:-

1- Stability was found to be (8) hours in room temperature due to risk of contamination.

2- Stability was found to be (24) hours in refrigerator

 

(Attached are detailed and highlighted references from Trissel IV Manual)

 

3- I’d like to go with Naveed regarding the preferable use of Alteplase over Streptokinase because:-

 

1. A) Stability of reconstituted Alteplase at concentration of (1mg/ml) in SWFI then frozen at (-20 C) is (6 months in polypropylene syringes) and (32 days in glass vials).

(Reference:- HandBook on injectable drugs 18^th Edition)

1. B) Lower risk of complications than streptokinase

Thanks for such refreshing inquiry.

[Rani Sudarshana]

Dear Nawal,

– Generally speaking, initial treatment of intrinsic catheter-related thrombosis can be attempted within the hemodialysis facility and consists of first a forceful saline flush (risk of catheter rupture), and if not successful, intraluminal lytic enzyme instillation. If these 2 approaches didn’t work, then the catheter needs to be replaced.

– I think using 3 ml and wasting 97 ml (72750 IU) is not a cost-effective option, taking into consideration the high cost of Streptokinase that can be saved for other indications.

– Most of the available evidence recommended using catheter instillation with Alteplase 1-2 mg, which is available in appropriate strength to prevent unnecessary waste.

– In the past, urokinase was used as the agent of choice for this purpose and was reasonably effective. However, tissue plasminogen activator (tPA) has replaced urokinase for this purpose and has been shown to be significantly more effective 1,2,3.

– we are using intra-catheter Alteplase (Cathflo) 1-2 mg for catheter occlusion which seems safe, effective and cost-effective option.

– Check the attached file for dilution & stability information of the Streptokinase.

References:
1- Eyrich H, et al. Alteplase versus urokinase in restoring blood flow in hemodialysis-catheter thrombosis. J Health Syst Pharm. 2002;59(15):1437.
2- Haire WD, et al.Urokinase versus recombinant tissue plasminogen activator in thrombosed central venous catheters: a double-blinded, randomized trial. 1994;72(4):543.
3- Zacharias JM, et al. Alteplase versus urokinase for occluded hemodialysis catheters. Ann Pharmacother. 2003;37(1):27.

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