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Streptokinase

Fibrinolytic (bacterial plasminogen activator) · Thrombolytic

START
AMI 1.5 million units IV over 30–60 min (if PCI unavailable, within window, no contraindication)
TYPICAL MAX
AMI single 1.5 million-unit regimen
STOP IF
Major bleeding (esp. intracranial — stop, reverse), anaphylaxis, severe refractory hypotension
WATCH
Bleeding/neuro status, BP during infusion, allergic reaction, do not re-use within 6–12 months
CDSCO approvedATC B01AD01
Renal dose adjustmenteGFR mL/min/1.73m²
FULLNo dose adjustment at any eGFR≥90

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours
6minONSET30minPEAK30mint½1dDURATION
ONSET
6min · fibrinolysis onset
PEAK
30min · during infusion
t½
30min · complex t½ (illustrative)
DURATION
1d · systemic lytic state
EXCRETION
Antibody/reticuloendothelial clearance; not renal
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid except life-threatening (massive PE) — bleeding/placental risk; does not cross placenta significantly
FDA category + note
Top interactionssee all 12 →
  • Tranexamic AcidContraindicatedDatabaseDDInter
  • AbciximabSevereDatabaseDDInter
  • AcalabrutinibSevereDatabaseDDInter
  • ApixabanSevereDatabaseDDInter
Available in India

28 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Forms a 1:1 activator complex with plasminogen that converts circulating and fibrin-bound plasminogen to plasmin, lysing fibrin thrombi; non-fibrin-specific (systemic fibrinogenolysis); antigenic (Streptococcus-derived).

Indications

Acute ST-elevation myocardial infarction (where primary PCI unavailable)Massive pulmonary embolism with haemodynamic instabilityAcute extensive deep-vein thrombosis / arterial thrombosis (selected)Occluded arteriovenous cannulae/catheters

Dosing

Adult
AMI: 1.5 million units IV over 30–60 min. PE/DVT: 250,000 units IV over 30 min loading then 100,000 units/h for 24–72 h.
Pediatric
Specialist only (rarely used).
Renal adjustment
No specific adjustment.
Hepatic adjustment
Caution in severe hepatic impairment (coagulopathy/bleeding).
Geriatric
Higher bleeding/ICH risk; weigh benefit.
Max dose
AMI 1.5 million units single regimen

Pharmacokinetics

Onset
Fibrinolysis within minutes
Peak effect
During infusion
Duration
Systemic lytic state hours (fibrinogen depletion up to 24 h)
Half-life
Complex/biphasic ~18–80 min
Bioavailability
IV
Protein binding
Antibody-bound (variable)
Metabolism
Proteolytic degradation/antibody clearance
Excretion
Reticuloendothelial; not renal

Contraindications

  • Active internal bleeding / recent major surgery or trauma
  • Prior intracranial haemorrhage; ischaemic stroke <3 months; intracranial neoplasm/AVM/aneurysm
  • Severe uncontrolled hypertension
  • Bleeding diathesis; recent (≤6–12 months) streptokinase use or recent streptococcal infection (antibodies → ineffective/allergic)

Side effects

Common
Bleeding/oozing at puncture sitesHypotension during infusionAllergic reactions (fever, rash, flushing)Reperfusion arrhythmias (AMI)
Serious
  • Major haemorrhage incl. intracranial
  • Anaphylaxis/severe allergic reaction (antigenic)
  • Severe hypotension
  • Cholesterol embolisation; reperfusion arrhythmia

Pregnancy & lactation

Pregnancy

Avoid except life-threatening (massive PE) — bleeding/placental risk; does not cross placenta significantly

Lactation

Acute single use; brief interruption advised — limited data

Drug interactions

Tranexamic Acid
Contraindicated
Database

Tranexamic acid inhibits fibrinolysis, directly counteracting the thrombolytic effect of streptokinase. This renders streptokinase ineffective and may increase the risk of re-thrombosis.

Concomitant use is contraindicated. Tranexamic acid should not be administered with fibrinolytic agents.

Source: DDInter

Abciximab
Severe
Database

Clinical effect not specified

Source: DDInter

Acalabrutinib
Severe
Database

Drug interaction classified as: synergy

Source: DDInter

Apixaban
Severe
Database

Drug interaction classified as: synergy

Source: DDInter

Argatroban
Severe
Database

Clinical effect not specified

Source: DDInter

Avapritinib
Severe
Database

Drug interaction classified as: synergy

Source: DDInter

Betrixaban
Severe
Database

Drug interaction classified as: synergy

Source: DDInter

Bivalirudin
Severe
Database

Clinical effect not specified

Source: DDInter

Cabozantinib
Severe
Database

Drug interaction classified as: synergy

Source: DDInter

Cangrelor
Severe
Database

Clinical effect not specified

Source: DDInter

Caplacizumab
Severe
Database

Clinical effect not specified

Source: DDInter

Dalteparin
Severe
Database

Clinical effect not specified

Source: DDInter

Related guidelines

ST-elevation myocardial infarction
CSI · Cardiology · 2020
Chronic obstructive pulmonary disease
ICS · Pulmonology · 2022
Extrapulmonary tuberculosis
ICMR · Infectious Diseases · 2022
Acute coronary syndrome
CSI · Cardiology · 2022
Primary PCI for acute coronary syndrome
ESC · Cardiology · 2026

Ask House about Streptokinase

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Sources: KD Tripathi 7e, Harrison 22e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19