INDIKINASE™ is a highly purified streptokinase produced by Recombinant technology using the specific gene of Streptococcus equisimilis, expressed in E. coli.

Clinical Pharmacology
Streptokinases do not have any intrinsic proteolytic activity. It forms a stable noncovalent complex with plasminogen. The “activator complex” cleaves free plasminogens in the serum. Plasmin is an enzyme that digests Fibrin in clots and thrombotic foci.

Varying levels of antibodies to Streptokinase are universally prevalent in the general population as a sequence to the ubiquitous Streptococcal infections, Through these antibodies interfere with Streptokinase activity they are completely depleted at the high dosage it is used. The half-life of Streptokinase in the body is 40 to 60 minutes after administration.

Large randomized studies namely ISIS-2 (1988), GISSI-2 (1990) and ISIS-2 (1992) have clearly demonstrated that intravenous infusion of 1,500,000 IU of Streptokinase significantly reduces mortality due to acute Myocardial infarction in another study, an accelerated 20 minutes intravenous infusion was also shown to be safe and effective. ISIS-2 study also has highlighted the advantage of using of 160mg/day of Aspirin in reducing to interactions. ISIS-3 showed excessive hemonhagic complications when Heparin and other anticoagulants are used in combination with Streptokinase.

Indications
INDIKINASE™ is indicated for patients with acute evolving Myocardial infarction (within 24 hours of onset) either by Intravenous or intra cardiac administration.

It is also useful in deep vein thrombosis and pulmonary embolism, Arterial occlusions. Hemodialysis shunts obstructions, intra-pleural adherences. Catheter occlusions and Prosthetic valve thrombi.

Contraindications
Thrombolytic therapy increases the risk of bleeding. INDIKINASE™ should be used with caution. It should not be used in case of severs allergic or anaphylactic response to the preparation.

INDIKINASE™ is contraindicated in the following situations:

• Active internal or external bleeding
• Recent (within 2 months) Cerebrovascular accident, intracranial or intraspinal surgery
• Severe uncontrolled hypertension

Dosage
INDIKINASE™ should be reconstituted with sterile normal saline (Sodium Chloride in I.P.) and diluted appropriately before use. Because of the protein nature of the preparation, slight flocculation (cloudy emulsion) may occur upon reconstitution, which will disappear on dilution.

Acute Myocardial Infarction:
Intravenous therapy:
INDIKINASE™ 1,500,000 IU in 60 minutes.
(Suggestion: INDIKINASE™ 1,500,000 IU may be infused in 50 ml of sterile sodium chloride Inj. I.P. in 60 minutes).

Intra-cardiac therapy:
INDIKINASE™ 20,000 IU as a bolus followed by 2,000 to 4000 IU minute for 60 to 90 minutes as maintenance dose. (Suggestion: INDIKINASE™ 250,000 IU within 30minutes as a loading dose. This should  be followed by 1,500,000 IU per hour for 6 hours which may be repeated the next day. Alternatively, 100,000 IU /hour may be infused for upto 72 hours depending on the severity of occlusion. Streptokinse therapy should never be continued after 5 days.

Arterio-venous cannulae:
INDIKINASE™ 250,000 IU should be reconstituted in 2 ml of Sodium Chloride Inj. I.P. and slowly injected.

Adverse Reactions

1. Bleeding
2. Allergic Reactions
3. Embolisms
4. Other reactions