EPTIFIBATIDE (Integrilin)
Name: |
EPTIFIBATIDE (IntegrilinR) |
Classification: |
platelet glycoprotein IIb/IIIa receptor antagonist
- inhibits platelet aggregation
- indicated for preventing adverse thromboembolic phenomena in patients with unstable angina or non-Q-wave myocardial infarction and those undergoing percutaneous coronary intervention
- intended for use with heparin and aspirin
|
Dose: |
IV Direct:
- IV direct by MD only
- initiate infusion immediately after first bolus is given
- MD to administer second bolus dose 10 minutes after first bolus
Percutaneous coronary interventions (PCI):
- 180 mcg/kg given immediately prior to beginning the procedure followed by immediate initiation of infusion
- administer second bolus immediately by infusion
|
Administration: |
IV Infusion:
75 mg/100 ml vials (0.75 mg/mL)
- infuse at 2 mcg/kg/min
- administer undiluted from vial
Percutaneous coronary interventions (PCI):
- continue infusion for 12-24 hours post PCI
Unstable angina/non-ST elevation myocardial infarction:
- continue infusion for up to 72 hours
- patients proceeding to PCI shoudl be continued up to 12 hours post-procedure
Integrilin Dosing Chart by Weight for Patients with Unstable Angina/Non-Q wave MI (180ug/kg Bolus and 2ug/kg/min Infusion)
Patient Weight
(kg) |
Bolus Volume in ml
(2 mg/ml) |
Infusion Rate in ml/h
(0.75mg/ml) |
37-41 |
3.4 |
6 |
42-46 |
4 |
7 |
47-53 |
4.5 |
8 |
54-59 |
5 |
9 |
60-65 |
5.6 |
10 |
66-71 |
6.2 |
11 |
72-78 |
6.8 |
12 |
79-84 |
7.3 |
13 |
85-90 |
7.9 |
14 |
91-96 |
8.5 |
15 |
97-103 |
9 |
16 |
104-109 |
9.5 |
17 |
110-115 |
10.2 |
18 |
116-121 |
10.7 |
19 |
>121 |
11.3 |
20 |
Dosing in Renal Dysfunction
Creatinine Clearance
|
Infusion Rate |
Greater than 50 mL/min (0.8 mL/second) |
Usual rate (2 mcg/kg/min) |
24-50 mL/min (0.4-0.8 mL/second) |
1 mcg/kg/min |
Less than 24 mL/min (0.4 mL/second) |
CONTRAINDICATED |
|
Contraindications: |
- in patients with history of bleeding diathesis or evidence of active abnormal bleeding within the previous 30 days
- severe hypertension (SBP>200 or DBP>110) not adequately controlled on antihypertensive therapy
- major surgery within the preceding 6 weeks
- history of stroke within 30 days or any history of hemorrhagic stroke
- platelet count < 100
- serum creatinine >165 or dependence on hemodialysis
- clinically significant liver disease
|
Adverse Effects: |
- bleeding (major bleeding in 5-11% of patients including intracranial, gastrointestinal, genitourinary or arterial puncture site)
- thrombocytopenia
|
Caution: |
- should be used cautiously with other medications that affect hemostasis, including oral anticoagulants, non-steroidal antiinflammatories, dipyridamole, ticlopidine and clopidogrel
|
Monitoring Therapy: |
- INR/PTT
- platelet count; hemoglobin
- bleeding (continues for 4-6 hours post discontinuation)
- neurological status, GI/GU bleeding, punctures sites
- continuous heart rate and rhythm
|
Adult Critical Care Protocol: |
|
Last Revised: September 20, 2018 (BM) |