Eptifibatide

A to Z Drug Facts

 Action Inhibits platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor, and other adhesive ligands to glycoprotein IIb/IIIa.

 Indications Treatment of acute coronary syndrome, including patients managed medically and those undergoing percutaneous coronary intervention (PCI); treatment of PCI, including patients undergoing intracoronary stenting.

 Contraindications History of bleeding diathesis; evidence of active abnormal bleeding within previous 30 days; severe hypertension (systolic BP greater than 200 mmHg or diastolic BP greater than 110 mmHg); major surgery within preceding 6 weeks; history of stroke within 30 days; history of hemorrhagic stroke; current or planned administration of another parenteral glycoprotein IIb/IIIa inhibitor; dependence on renal dialysis; hypersensitivity to any component of the product.

 Route/Dosage

Acute Coronary Syndrome

Adults: Serum creatinine less than 2 mg/dL: IV bolus 180 mcg/kg as soon as possible after diagnosis followed immediately by continuous infusion of 2 mcg/kg/min until hospital discharge or initiation of coronary artery bypass graft surgery, up to 72 hr. If patient is to undergo PCI while receiving eptifibatide, continue infusion up to discharge, or up to 18 to 24 hr after procedure, whichever occurs first, allowing for 96 hr of therapy. Patients weighing more than 121 kg should receive a max bolus of 22.6 mg followed by a max infusion rate of 15 mg/hr.

Adults: Serum creatine 2 to 4 mg/dL: IV bolus 180 mcg/kg as soon as possible after diagnosis followed by continuous infusion of 1 mcg/kg/min. Patients weighing more than 121 kg should receive a max bolus of 22.6 mg followed by a max infusion rate of 7.5 mg/hr.

Percutaneous Coronary Intervention

Adults: Serum creatinine less than 2 mg/dL: IV bolus 180 mcg/kg immediately before initiation of PCI followed by continuous infusion of 2 mcg/kg/min and a second 180 mcg/kg bolus 10 min after the first bolus. Continue infusion until hospital discharge or up to 18 to 24 hr, whichever occurs first. A minimum of 12 hr of infusion is recommended. Patients weighing more than 121 kg should receive a max bolus of 22.6 mg followed by a max infusion rate of 15 mg/hr.

Adults: Serum creatinine 2 to 4 mg/dL: IV bolus 180 mcg/kg immediately before initiation of PCI, immediately followed by continuous infusion of 1 mcg/kg/min and a second 180 mcg/kg bolus 10 min after the first bolus. Patients weighing more than 121 kg should receive a max bolus of 22.6 mg followed by a max infusion rate of 7.5 mg/hr.

 Interactions

Dipyridamole, Nonsteroidal Anti-Inflammatory Agents, Oral Anticoagulants, Thrombolytics: Use with caution because eptifibatide inhibits platelet aggregation.

Inhibitors of Platelet Receptor Glycoprotein IIb/IIIa Inhibitors: Avoid because of additive pharmacologic effects with eptifibatide.

 Lab Test Interferences None well documented.

 Adverse Reactions

EENT: Oropharyngeal bleeding. GI: Bleeding. GU: Bleeding. HEMATOLOGIC: Intracranial hemorrhage; spontaneous gross hematuria; spontaneous hematemesis; major bleeding; minor bleeding; bleeding at femoral artery access site. OTHER: Retroperitoneal bleeding.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established. Bleeding: Take special care to minimize risk of bleeding. Platelet Count: Use with caution in patients with a platelet count less than 100,000/mm³. Trauma: Minimize use of arterial or venous punctures, IM injections, use of urinary catheters, nasotracheal intubation, and nasogastric tubes.

 Administration/Storage

• For IV use only. Not for intra-arterial, SC, IM, or ID administration.
• Eptifibatide is administered as an IV bolus dose (180 mcg/kg, not to exceed 22.6 mg) followed immediately by an IV infusion (2 mcg/kg/min, not to exceed 15 mg/hr.)
• Administer reduced infusion dose (1 mcg/kg/min, not to exceed 7.5 mg/hr) to patient with serum creatinine between 2 to 4 mg/dL.
• Withdraw bolus dose from 10 mL vial into a syringe. Administer the bolus dose by IV push.
• Administer continuous infusion undiluted directly from 100 mL vial via IV infusion pump using vented infusion set.
• Administer IV infusion in same IV line with 0.9% Sodium Chloride or 0.9% Sodium Chloride with 5% Dextrose.
• May be administered in same IV line with potassium chloride, alteplase, atropine, dobutamine, heparin, lidocaine, meperidine, metoprolol, midazolam, morphine, nitroglycerin, or verapamil.
• Do not administer in IV line containing furosemide.
• Discontinue eptifibatide infusion prior to coronary artery bypass graft surgery.
• Do not administer if particulate matter or discoloration is noted.
• Store vials in refrigerator (36° to 46°F). May be transferred for storage at controlled room temperature (59° to 86°F) for up to 2 mo. Protect from light until administration.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of bleeding disorders; evidence of active abnormal bleeding within previous 30 days; uncontrolled severe hypertension; major surgery within preceding 6 wks; history of stroke within 30 days or any history of hemorrhagic stroke; dependency on renal dialysis; current or planned administration of another parenteral GP IIb/IIIa inhibitor; or concurrent use of thrombolytic agent, oral anticoagulant, non-steroidal anti-inflammatory drug, or dipyridamole.
• Administer appropriate doses of heparin and aspirin concomitantly if indicated.
• Ensure that baseline hematocrit or hemoglobin, platelet count, serum creatinine, and PT/aPTT are performed and evaluated prior to starting therapy. Perform an activated clotting time (ACT) and evaluate prior to starting therapy in patients undergoing PCI.
• Maintain aPTT between 50 to 70 sec in patients treated concurrently with heparin unless PCI is to be performed. Maintain ACT between 200 to 300 sec during PCI.
• Determine aPTT or ACT prior to removal of arterial sheath. Do not remove sheath until aPTT is less than 45 sec or ACT is less than 150 sec.
• Monitor patient for unusual bleeding or bruising, especially at vascular access sites, and report to health care provider if noted.
• Discontinue eptifibatide and heparin if platelet count decreases to less than 100,000/mm³.
• Minimize arterial and venous punctures, IM injections, and use of urinary catheters, nasotracheal intubation, and nasogastric tubes while patient is receiving eptifibatide.
• Avoid IV access through noncompressible sites (eg, subclavian or jugular veins).
• Monitor patient for evidence of ongoing myocardial ischemia or hemodynamic instability. Report to health care provider if noted.

 Patient/Family Education

• Explain name, action, and potential side effects of drug.
• Advise patient, family, or caregiver that medication will be prepared and administered by health care provider in a health care setting.
• Advise patient, family, or caregiver that medication may be used in combination with other agents, including aspirin and heparin, to achieve maximum benefit possible.
• Review dosing schedule with patient, family, or caregiver.
• Advise patient, family, or caregiver to report any unusual bleeding or bruising to health care provider while medication is being administered.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts