Kinlytic
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Questions & Answers
Side Effects & Adverse Reactions
The risk of serious bleeding is increased with use of Kinlytic™. Fatalities due to hemorrhage, including intracranial and retroperitoneal, have been reported in association with urokinase therapy.
Concurrent administration of Kinlytic™ with other thrombolytic agents, anticoagulants, or agents inhibiting platelet function may further increase the risk of serious bleeding.
Kinlytic™ therapy requires careful attention to all potential bleeding sites (including catheter insertion sites, arterial and venous puncture sites, cutdown sites, and other needle puncture sites).
Intramuscular injections and nonessential handling of the patient must be avoided during treatment with Kinlytic™. Venipunctures should be performed as infrequently as possible and with care to minimize bleeding.
Should an arterial puncture be necessary, upper extremity vessels are preferable. Direct pressure should be applied for at least 30 minutes, a pressure dressing applied, and the puncture site checked frequently for evidence of bleeding.
In the following conditions, the risk of bleeding may be increased and should be weighed against the anticipated benefits:
- Recent (within 10 days) major surgery, obstetrical delivery, organ biopsy, previous puncture of non-compressible vessels
- Recent (within 10 days) serious gastrointestinal bleeding
- High likelihood of a left heart thrombus, for example, mitral stenosis with atrial fibrillation
- Subacute bacterial endocarditis
- Hemostatic defects including those secondary to severe hepatic or renal disease
- Pregnancy
- Cerebrovascular disease
- Diabetic hemorrhagic retinopathy
- Any other condition in which bleeding might constitute a significant hazard or be particularly difficult to manage because of its location
When internal bleeding occurs, it may be more difficult to manage than that which occurs with conventional anticoagulant therapy. Should potentially serious spontaneous bleeding (not controllable by direct pressure) occur, the infusion of Kinlytic™ should be terminated immediately, and measures to manage the bleeding implemented. Serious blood loss may be managed with volume replacement, including packed red blood cells. Dextran should not be used. When appropriate, fresh frozen plasma and/or cryoprecipitate may be considered to reverse the bleeding tendency.
Post-marketing reports of hypersensitivity reactions have included anaphylaxis (with rare reports of fatal anaphylaxis), bronchospasm, orolingual edema and urticaria (see ADVERSE REACTIONS: Allergic Reactions). There have also been reports of other infusion reactions which have included one or more of the following: fever and/or chills/rigors, hypoxia, cyanosis, dyspnea, tachycardia, hypotension, hypertension, acidosis, back pain, vomiting, and nausea. Reactions generally occurred within one hour of beginning Kinlytic™ infusion. Patients who exhibit reactions should be closely monitored and appropriate therapy instituted.
Infusion reactions generally respond to discontinuation of the infusion and/or administration of intravenous antihistamines, corticosteroids, or adrenergic agents.
Antipyretics which inhibit platelet function (aspirin and other non-steroidal anti-inflammatory agents) may increase the risk of bleeding and should not be used for treatment of fever.
Cholesterol embolism has been reported rarely in patients treated with all types of thrombolytic agents; the true incidence is unknown. This serious condition, which can be lethal, is also associated with invasive vascular procedures (e.g., cardiac catheterization, angiography, vascular surgery) and/or anticoagulant therapy. Clinical features of cholesterol embolism may include livedo reticularis, “purple toe” syndrome, acute renal failure, gangrenous digits, hypertension, pancreatitis, myocardial infarction, cerebral infarction, spinal cord infarction, retinal artery occlusion, bowel infarction and rhabdomyolysis.
Kinlytic™ is made from human neonatal kidney cells grown in tissue culture. Products made from human source material may contain infectious agents, such as viruses, that can cause disease. The risk that Kinlytic™ will transmit an infectious agent has been reduced by screening donors for prior exposure to certain viruses, by testing donors for the presence of certain current virus infections, by testing for certain viruses during manufacturing, and by inactivating and/or removing certain viruses during manufacturing (see DESCRIPTION). Despite these measures, Kinlytic™ may carry a risk of transmitting infectious agents, including those that cause Creutzfeldt-Jakob disease (CJD) or other diseases not yet known or identified; thus, the risk of transmission of infectious agents cannot be totally eliminated. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) is considered extremely remote.
This product is formulated in 5% albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, albumin carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) also is considered extremely remote. No cases of transmission of viral diseases or CJD have ever been identified for albumin.
All infections thought by a physician possibly to have been transmitted by this product should be reported by the physician or other healthcare provider to ImaRx Therapeutics, Inc. [1-866-634-6279].
Legal Issues
There is currently no legal information available for this drug.
FDA Safety Alerts
There are currently no FDA safety alerts available for this drug.
Manufacturer Warnings
There is currently no manufacturer warning information available for this drug.
FDA Labeling Changes
There are currently no FDA labeling changes available for this drug.
Uses
Kinlytic™ 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 non-invasive procedures such as lung scanning.
History
There is currently no drug history available for this drug.
Other Information
Kinlytic™ (urokinase for injection) is a thrombolytic agent obtained from human neonatal kidney cells grown in tissue culture. The principal active ingredient of Kinlytic™ is the low molecular weight form of urokinase, and consists of an A chain of 2,000 daltons linked by a sulfhydryl bond to a B chain of 30,400 daltons. Kinlytic™ is supplied as a sterile lyophilized white powder containing 250,000 international units urokinase per vial, mannitol (25 mg/vial), Albumin (Human) (250 mg/vial), and sodium chloride (50 mg/vial).
Following reconstitution with 5 mL of Sterile Water for Injection, USP, Kinlytic™ is a clear, slightly straw-colored solution; each mL contains 50,000 international units of urokinase activity, 0.5% mannitol, 5% Albumin (Human), and 1% sodium chloride (pH range 6.0 to 7.5).
Thin translucent filaments may occasionally occur in reconstituted Kinlytic™ vials (see DOSAGE AND ADMINISTRATION).
Kinlytic™ is for intravenous infusion only.
Kinlytic™ is produced from human neonatal kidney cells (see WARNINGS). No fetal tissue is used in the production of Kinlytic™. Kidney donations are obtained exclusively in the United States from neonates (birth to 28 days) for whom death has not been attributed to infectious causes and that have exhibited no evidence of an infectious disease based in part, on an examination of the maternal and neonatal donor medical records. The maternal and neonatal donor screening process also identifies specific risk factors for known infectious diseases and includes testing of sera for HBV, HCV, HIV-1, HIV-2, HTLV-I, HTLV-II, CMV, and EBV. Donors with sera testing positive or associated with other risk factors are excluded. During the manufacturing process, cells are tested at multiple stages for the presence of viruses using in vitro and in vivo tests that are capable of detecting a wide range of viruses. Cells are also screened for HPV using a DNA detection-based test and for reovirus using a polymerase chain reaction-based test. The manufacturing process used for this product has been validated in laboratory studies to inactivate and/or remove a diverse panel of spiked model enveloped and non-enveloped viruses, and includes purification steps and a heat treatment step (10 hours at 60°C in 2% sodium chloride). A single vial of Kinlytic™ contains urokinase produced using cells derived from one or two donors.
Sources
Kinlytic Manufacturers
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Imarx Therapeutics, Inc.
![Kinlytic (Urokinase) Injection, Powder, Lyophilized, For Solution [Imarx Therapeutics, Inc.]](/wp-content/themes/bootstrap/assets/img/loading2.gif)
Kinlytic | Imarx Therapeutics, Inc.
Kinlytic™ IS INTENDED FOR INTRAVENOUS INFUSION ONLY.
Kinlytic™ 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 A loading dose of 4,400 international units per kilogram of Kinlytic™ is given 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 at a rate of 15 mL for 12 hours. Administration of Kinlytic™ 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 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™ contains no preservatives. Do not reconstitute until immediately before use. Any unused portion of the reconstituted material should be discarded. Reconstitute Kinlytic™ 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™ 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™ 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™ 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™ for administration. For administration directions, see next section.
Dose Preparation-Pulmonary Embolism a Loading Dose + dose administered during 12-hour period. b Each vial is reconstituted with 5 mL of Sterile Water for Injection, USP, without preservatives. (See Preparation.) 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™
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 Administration Kinlytic™ is administered using a constant infusion pump that is capable of delivering a total volume of 195 mL. The loading dose of Kinlytic™ 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™ at a rate of 15 mL per hour for 12 hours. Since some of the Kinlytic™ 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™ is administered. A solution of 0.9% Sodium 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™ 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™. Anticoagulation After Terminating Kinlytic™ TreatmentAfter infusing Kinlytic™, 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.
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