Generic Name :

Tirofiban

Trade Name :

Aggrastat

Action:

A non-peptide antagonist of the platelet glycoprotein IIB/IIIA receptor, which inhibits platelet aggregation.

Indications:

The treatment of Acute Coronary Syndrome ( Unstable angina and Non Q Wave Myocardial Infarction), in combination with heparin, including patients who are medically managed and those undergoing PTCA or atherectomy.

Administration and Dosage :

Tirofiban is administered as an IV bolus followed by a continuous IV infusion

Bolus Dose :

0.4 micrograms/ kg/ min for 30 minutes

Maintenance Infusion:

0.1 micrograms/ kg/ min. through angiography , for 12 to 24 hours after angioplasty, 48 to 96 hours for medically managed patients.

Dosing in Renal Insufficiency:

In-patients with renal Insufficiency defined as Cr Cl <30ml/min, the maintenance infusion and bolus doses should be half the usual rate/dose

Tirofiban is removed by hemodialysis

Standard Concentration:

Premixed bags of 12.5mg in 250ml (50mcg/ml)

EW Standard

Premixed bags of 12.5mg in 250ml (50mcg/ml)

Contraindications :

Tirofiban is contraindicated in-patients with a known hypersensitivity

Active internal bleeding or a history of a bleed within the previous 30 days

A History of intracranial hemorrhage, intracranial neoplasm ,arteriovenous malformation, or aneurysm.

A history of thrombocytopenia following prior exposure to tirofiban

A history of hemorrhagic stroke, or stroke within 30 days

Major surgery or trauma within the past 30 days

History, symptoms or findings suggestive of aortic dissection

Severe hypertension (SBP >180 mmHg/ or DBP > 110mmHg)

Acute pericarditis.

Precautions:

Use with caution in-patients with a platelet count < 150,000/mm3,

Patients with hemorrhagic retinopathy

When bleeding cannot be controlled with pressure, immediately stop tirofiban and heparin.

Use with caution with other drugs that affect hemostasis: NSAIDs, oral anticoagulants, dipyridamole, clopidogrel, ticlopidine.

Minimize Vascular and other trauma

Monitor Platelet counts, 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 heparin infusion and APTT maintained at approximately 2x control.

If the patient experiences a platelet decrease of <90,000/ mm3 perform additional platelet counts to exclude pseudothrombocytopenia. If thrombocytopenia is confirmed stop tirofiban and heparin, monitor and treat accordingly.

Side Effects:

Increased incidence of bleeding major and minor.

Nausea, fever, headache