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Kinlytic

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Kinlytic

Indications
Dosage
How Supplied

INDICATIONS

Kinlytic™ (urokinase injection) is indicated in adults:

  • For the lysis of acute massive pulmonary emboli, defined as obstruction of blood flow to a lobe or multiple segments.
  • For the lysis of pulmonary emboli accompanied by unstable hemodynamics, i.e., failure to maintain blood pressure without supportive measures.

The diagnosis should be confirmed by objective means, such as pulmonary angiography or noninvasive procedures such as lung scanning.

DOSAGE AND ADMINISTRATION

Kinlytic™ (urokinase injection) IS INTENDED FOR INTRAVENOUS INFUSION ONLY.

Kinlytic™ (urokinase injection) treatment should be instituted soon after onset of pulmonary embolism. Delay in instituting therapy may decrease the potential for optimal efficacy (see CLINICAL PHARMACOLOGY).

Dosing

Administer Kinlytic™ (urokinase injection) with a programmable infusion pump only.

Change the infusion rate immediately after completion of the loading dose.

  • The loading dose of 4,400 international units per kilogram of Kinlytic™ (urokinase injection) is given at a rate of 90 mL per hour over a period of 10 minutes.
  • This is followed with a continuous infusion of 4,400 international units per kilogram per hour at a rate of 15 mL for 12 hours.
  • Administration of Kinlytic™ (urokinase injection) may be repeated as necessary.
  • A dosing and preparation chart for patients who weigh 37 to 114 kilograms (81 to 250 pounds) is provided as a guide in the Preparation Section that follows below. If the patient is outside of these weights, calculate with dosing information provided above.

Preparation

  • Administer Kinlytic™ (urokinase injection) with a programmable infusion pump only. Change the infusion rate immediately after completion of the loading dose to the maintenance dose rate.
  • The Dose Preparation-Pulmonary Embolism chart is a guidance tool/aid provided for the convenience of the practitioner and may not be complete for every patient.
  • Kinlytic™ (urokinase injection) contains no preservatives. Do not reconstitute until immediately before use. Any unused portion of the reconstituted material should be discarded.
  • Reconstitute Kinlytic™ (urokinase injection) by aseptically adding 5 mL of Sterile Water for Injection, USP, without preservatives, to the vial. DO NOT USE Bacteriostatic Water for Injection, USP.
  • After reconstitution, the drug product will contain 50,000 international units per milliliter.
  • After reconstituting, visually inspect each vial of Kinlytic™ (urokinase injection) for discoloration and for the presence of particulate material. The solution should be pale and straw-colored; highly colored solutions should not be used. Thin translucent filaments may occasionally occur in reconstituted Kinlytic™ (urokinase injection) vials, but do not indicate any decrease in potency of this product. To minimize formation of filaments, avoid shaking the vial during reconstitution. Roll and tilt the vial to enhance reconstitution. The solution may be terminally filtered, for example, through a 0.45 micron or smaller cellulose membrane filter.
  • No other medication should be added to this solution.
  • Prior to infusing, dilute the reconstituted Kinlytic™ (urokinase injection) with 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP.

The following Dose Preparation-Pulmonary Embolism chart may be used as an aid in the preparation of Kinlytic™ (urokinase injection) for administration. For administration directions, see next section.

Dose Preparation-Pulmonary Embolism
For administration, use a programmable infusion pump only.
After ten minutes, change the initial loading dose rate to the maintenance dose rate.

Patient Weight [kilograms (pounds)] Total Dosea (Loading and Continuous Infusion) Number of Kinlytic™ Vials Needed for Total Dose Total Volume of Sterile Water for Injection needed for Reconstitution of Kinlytic™ (urokinase injection) Vialsb + Volume of 0.9% Sodium Chloride or 5% Dextrose Injection, USP for Infusion (mL) = Final Volume (mL) for Loading and Continuous Infusion
37-40 (81-90) 2,250,000 9 45   150   195
41-45 (91-100) 2,500,000 10 50   145   195
46-50 (101-110) 2,750,000 11 55   140   195
51-54(111-120) 3,000,000 12 60   135   195
55-59(121-130) 3,250,000 13 65   130   195
60-64 (131-140) 3,500,000 14 70   125   195
65-68(141-150) 3,750,000 15 75   120   195
69-73 (151-160) 4,000,000 16 80   115   195
74-77 (161-170) 4,250,000 17 85   110   195
78-82 (171-180) 4,500,000 18 90   105   195
83-86 (181-190) 4,750,000 19 95   100   195
87-91 (191-200) 5,000,000 20 100   95   195
92-95 (201-210) 5,250,000 21 105   90   195
96-100 (211-220) 5,500,000 22 110   85   195
101-104 (221-230) 5,750,000 23 115   80   195
105-109 (231-240) 6,000,000 24 120   75   195
110-114 (241-250) 6,250,000 25 125   70   195
aLoading Dose + dose administered during 12-hour period.
bEach vial is reconstituted with 5 mL of Sterile Water for Injection, USP, without preservatives. (See Preparation.)

Administration

  • Kinlytic™ (urokinase injection) is administered using a programmable infusion pump. Change the infusion rate immediately after completion of the loading dose.
  • The loading dose of Kinlytic™ (urokinase injection) admixture (4,400 international units per kilogram) should be delivered at a rate of 90 mL per hour over a period of 10 minutes.
  • This is followed by a continuous infusion of 4,400 international units per kilogram per hour of Kinlytic™ (urokinase injection) at a rate of 15 mL per hour for 12 hours.
  • Since some of the Kinlytic™ (urokinase injection) admixture will remain in the tubing at the end of an infusion pump delivery cycle, the following flush procedure should be performed to insure that the total dose of Kinlytic™ (urokinase injection) is administered. A solution of 0.9% Sodi um Chloride Injection, USP, or 5% Dextrose Injection, USP, approximately equal in amount to the volume of the tubing in the infusion set should be administered via the pump to flush the Kinlytic™ (urokinase injection) admixture from the entire length of the infusion set. The pump should be set to administer the flush solution at the continuous rate of 15 mL per hour.
  • No other drug products/solutions may be administered in the same line with Kinlytic™ (urokinase injection) .

Anticoagulation After Terminating Kinlytic™ (urokinase injection) Treatment

After infusing Kinlytic™ (urokinase injection) , anticoagulation treatment is recommended to prevent recurrent thrombosis. Do not begin anticoagulation until the aPTT has decreased to less than twice the normal control value. If heparin is used, do not administer a loading dose of heparin. Treatment should be followed by oral anticoagulants.

HOW SUPPLIED

Kinlytic™ (urokinase injection) is supplied as a sterile lyophilized preparation (NDC 24430-1003-1). Each vial contains 250,000 international units urokinase activity, 25 mg mannitol, 250 mg Albumin (Human), and 50 mg sodium chloride.

Refrigerate Kinlytic™ (urokinase injection) powder at 2° to 8°C (36° to 46°F) (See USP).

REFERENCES

1. Sato S. et al. Elevated Urokinase-Type Plasminogen Activator Plasma Levels Are Associated With Deterioration of Liver Function But Not With Hepatocellular Carcinoma. J Gastroenterology, 1994; 29:745-750.

2. Bell WR. Thrombolytic Therapy: A Comparison Between Urokinase and Streptokinase. Sem Thromb Hemost. 1975; 2:1-13.

3. Sasahara AA, Hyers TM, Cole CM, et al. The Urokinase Pulmonary Embolism Trial. Circulation. 1973; 47 (suppl. 2):1-108.

4. Daniels LB, Parker JA, Patel SR, Grodstein F, Goldhaber SZ. Relation of Duration of Symptoms With Response to Thrombolytic Therapy in Pulmonary Embolism. Am J Cardiol. 1997; 80:184-188.

5. Urokinase Pulmonary Embolism Trial Study Group: Urokinase-Streptokinase Embolism Trial. JAMA. 1974; 229:1606-1613.

6. Sasahara AA, Bell WR, Simon TL, et al. The Phase II Urokinase-Streptokinase Pulmonary Embolism Trial. Thrombos Diathes Haemorrh (Stuttg). 1975; 33:464-476.

ImaRx Therapeutics, Inc. Tucson, Arizona 85718, USA. July 2008. FDA revision date: 07/18/08

Last reviewed on RxList: 8/7/2008
This monograph has been modified to include the generic and brand name in many instances.

Indications
Dosage
How Supplied
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