eptifibatide

(redirected from Integrilin)

eptifibatide

 [ep″tĭ-fib´ah-tīd]
an inhibitor of platelet aggregation used for prevention of thrombosis in patients with acute coronary syndrome or undergoing certain percutaneous coronary procedures; administered intravenously.

eptifibatide

Integrilin

Pharmacologic class: Platelet aggregation inhibitor

Therapeutic class: Antiplatelet agent

Pregnancy risk category B

Action

Decreases platelet aggregation by binding to platelet-receptor glycoprotein, preventing binding of fibrinogen to platelets, which causes thrombus formation

Availability

Injection: 10-ml vial (2 mg/ml), 100-ml vial (0.75 mg/ml)

Indications and dosages

Acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction)

Adults: 180 mcg/kg I.V. bolus over 1 to 2 minutes, followed by a continuous infusion of 2 mcg/kg/minute for up to 72 hours

Prevention of thrombosis related to percutaneous coronary intervention (PCI)

Adults: 180 mcg/kg I.V. bolus immediately before PCI, then a continuous infusion of 2 mcg/kg/minute, followed by a second 180-mcg/kg bolus 10 minutes after first bolus. Continue infusion until discharge or for up to 24 hours.

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug or its components

• Severe hypertension

• Bleeding disorders or evidence of active abnormal bleeding within previous 30 days

• Renal dialysis

• Recent cerebrovascular accident

• Recent surgery

• Current or planned administration of another parenteral Gp IIb/IIIa inhibitor

Precautions

Use cautiously in:

• renal insufficiency

• creatinine level below 2 mg/dl

• platelet count below 100,000/mm3

• elderly patients

• pregnant or breastfeeding patients

• children (safety and efficacy not established).

Administration

• Withdraw single bolus dose from 10-ml vial into syringe, and give by I.V. push over 1 to 2 minutes. Follow single I.V. bolus dose with continuous I.V. infusion given undiluted from 100-ml vial spiked with infusion set connected to infusion control device.

• Don't administer through same I.V. line as furosemide.

Adverse reactions

CNS: headache, dizziness, asthenia, syncope

CV: hypotension

GI: nausea, diarrhea, constipation

GU: hematuria

Hematologic: bleeding tendency, thrombocytopenia

Skin: flushing

Other: bleeding at femoral access site

Interactions

Drug-drug. Clopidogrel, dipyridamole, nonsteroidal anti-inflammatory drugs, oral anticoagulants, thrombolytics, ticlopidine: increased risk of bleeding Other platelet aggregation inhibitors: serious bleeding

Drug-diagnostic tests. Platelets: decreased count

Drug-herbs. Most commonly used herbs: increased anticoagulant effect of eptifibatide

Patient monitoring

• Monitor vital signs and assess cardiovascular status, especially for syncope and hypotension.

• Monitor coagulation studies, CBC, and platelet count. Watch for signs and symptoms of abnormal bleeding or bruising and hematuria.

• Check carefully for bleeding at all sites of invasive procedures, particularly femoral access site.

Patient teaching

• Tell patient drug may cause serious adverse effects but can help prevent a heart attack. Reassure him that he'll be closely monitored during therapy.

Instruct patient to immediately report fainting or abnormal bruising or bleeding.

• Teach patient safety measures to avoid bruising or bleeding.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

eptifibatide

Integrilin® Cardiology An antithrombotic GP IIb/IIIa receptor antagonist that blocks fibrinogen and von Willebrand factor from binding to the surface of activated platelets
References in periodicals archive ?
Net revenues from AGGRASTAT of USD6.1m were collected for the three months ended 31 March 2018, down from USD7.0m for the three months ended 31 March 2017, largely due to a stronger Canadian dollar compared to its US counterpart and increased competitive pricing of generic Integrilin.
Integrilin was not initiated due to a positive test for fecal occult blood and a slowly downtrending hemoglobin level.
Sparapani et al., "Clinical significance of thrombocytopenia during a non-ST-elevation acute coronary syndrome: the platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy (pursuit) trial experience," Circulation, vol.
Clinical scoring algorithms have been developed to aid in risk stratification, including the Global Registry for Acute Coronary Events (GRACE) (1), TIMI (Thrombolysis in Myocardial Infarction) risk score, (2), and PURSUIT [Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin (eptifibatide) Therapy] score (3).
However, higher adverse outcomes, such as increased bleeding rates, were observed in the EPIC trial which used 10,000-12,000 unit doses of heparin as compared to the current recommendation of 60 units/kg of heparin as used in the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial.
VerifyNow is a rapid, simple, and accurate system for measuring individual response to every major antiplatelet medication, including aspirin, Plavix, ReoPro, and Integrilin. Backed by clinical-training programs and a customer-support team, this system provides a simple and accurate tool to help guide treatment decisions.
Other important products are Temodar, a treatment for brain tumors; Integrilin for cardiovascular problems; Avelox, a treatment for bacterial infections; Intron A for cancer and viral infections; Subutex for opiate dependence; Caelyx for skin cancer; Cipro, an antibiotic; and Elocon for inflammatory skin conditions.
Different GPIIb/IIIa inhibitors--abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat)--are given intravenously before angioplasty or during a suspected heart attack.
The guidelines let physicians make a qualitative assessment of high, intermediate, or low risk on the basis of factors such as cardiac markers (especially troponin level), ECG, clinical findings, pain, and history, but they recommend going further and using one of the formal scoring systems that have been validated during the past few years: the Thrombolysis in Myocardial Infarction (TIMI), Global Registry of Acute Coronary Events (GRACE), or Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) scoring methods.
Although the guidelines allow physicians to make a qualitative assessment of high, intermediate, or low risk, on the basis of factors such as cardiac markers (especially troponin level), ECG, clinical findings, pain, and history, they recommend going further and using one of the formal scoring systems that have been validated during the past few years: the Thrombolysis in Myocardial Infarction (TIMI), the Global Registry of Acute Coronary Events (GRACE), or the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) scoring methods.
"With the thrombin receptor antagonist, TRA or SCH-530348, our novel investigational antiplatelet medication in late-stage development; the Merck/Schering-Plough cholesterol-lowering products VYTORIN and ZETIA; and INTEGRILIN, the leading GP IIb-IIIa inhibitor, acadesine further demonstrates our long-term commitment to developing treatments to address unmet needs in cardiac care."