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:

  • Must be administered by ay be administered by IV infusion and titrated by a nurse in Adult Critical Care

  • Continuous infusions must be administered by infusion device and the pump library must be enabled.

  • Placement of an arterial line for blood pressure monitoring is preferred
Last Revised: September 20, 2018 (BM)