Generic Name:

Eptifibatide

Trade Name :

Integrilin

Action:

A cyclic heptapeptide antagonist of the glycoprotein IIB/IIIA receptor, which inhibits platelet aggregation.

Indications:

Treatment of Acute Coronary Syndrome (Unstable Angina, Non Q Wave myocardial infarction), in combination with heparin, including patients that are to be medically managed and those undergoing percutaneous coronary intervention ( PCI )

Administration and Dosage :

Eptifibatide is administered as an IV bolus followed by a continuous infusion.

Bolus Dose :

• Acute coronary syndrome : Use 180 mcg/kg bolus (maximum: 22.6 mg)
• Percutaneous coronary intervention (PCI) with or without stenting : 180 mcg/kg bolus (max: 22.6 mg) administered immediately before initiation of PCI; a second 180 mcg/kg (max: 22.6 mg) bolus should be administered 10 minutes after first bolus
• No adjustment in bolus dose needed for renal dysfunction

Maintenance Dose:

• Acute coronary syndrome: 2 mcg/kg/minute infusion (maximum: 15 mg/hour)- up to 72 hours
• Percutaneous coronary intervention (PCI) with or without stenting (maintenance dose is initiated after first bolus) : 2 mcg/kg/minute (maximum: 15 mg/hour)

Dosing if ClCr is less than 50 mL/minute:

• Acute coronary syndrome: 1 mcg/kg/minute infusion (maximum: 7.5 mg/hour)- up to 72 hours
• Percutaneous coronary intervention (PCI) with or without stenting (maintenance dose is initiated after first bolus) : 1 mcg/kg/minute (maximum: 7.5 mg/hour)

How Supplied:

Premixed vials of 75mg per 100ml ( 0.75mg/ml)

EW Standard

Premixed vials of 75mg per 100ml ( 0.75mg/ml)

Contraindications:

• Known hypersensitivity to the drug, active internal bleeding, history of a bleed within last 30 days, major surgery within the last 6 weeks.
• History of stroke within the past 30 days or any history of hemorrhagic stroke, Platelet count < 100,000/mm3
• Dependency on renal dialysis
• Severe Hypertension (SBS > 200mmHg or DBS >110 mmHg)

Precautions:

• Use with caution in patients with a platelet count <150,000 mm3
• When bleeding cannot be controlled by pressure, immediately stop eptifibatide and heparin.
• Use with caution with other drugs that can affect hemostasis (e.g. NSAIDs, oral anticoagulants, dipyridamole, clopidogrel, ticlopidine, fondaparinux, direct thrombin inhibitors)
• Use with extreme caution in patients who are receiving thrombolytics
• Minimize vascular and other trauma
• Measure platelet count, hemoglobin, and hematocrit prior to treatment, within 6 hours following the loading infusion, and at least daily during therapy. Note: Heparin APTT should be measured 6 hours after the start of the heparin infusion and APTT maintained between 50 and 70.
• If the platelet count decreases to less than <100,000 mm3 stop eptifibatide and heparin, monitor and treat accordingly (may include HIT evaluation).

Side Effects :

•  Increased incidence of bleeding both major and minor

•  Thrombocytopenia

•  Hypotension, anaphylaxis ( uncommon )