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Pharmacologic class: Platelet aggregation inhibitor
Therapeutic class: Antithrombotic, antiplatelet drug
Pregnancy risk category C
Inhibits fibrinogen binding and platelet-platelet interaction by impeding fibrinogen binding to platelet receptor sites, thereby prolonging bleeding time
Injection: 2 mg/ml (5-ml vials containing 10 mg)
⊘Indications and dosages
➣ Adjunct to aspirin and heparin to prevent acute cardiac ischemic complications in patients undergoing percutaneous coronary intervention (PCI)
Adults: 0.25 mg/kg I.V. bolus given 10 to 60 minutes before start of PCI, followed by infusion of 0.125 mcg/kg/minute for 12 hours. Maximum dosage is 10 mcg/minute.
➣ Adjunct to aspirin and heparin in patients with unstable angina who haven't responded to conventional medical therapy and will undergo PCI within 24 hours
Adults: 0.25 mg/kg I.V. bolus, followed by 18- to 24-hour infusion of 10 mcg/minute, ending 1 hour after PCI
• Hypersensitivity to drug or murine proteins
• Active internal bleeding
• Bleeding diathesis
• Severe, uncontrolled hypertension
• Thrombocytopenia (< 100,000 cells/mm3)
• Arteriovenous malformation
• History of cerebrovascular accident
• Oral anticoagulant therapy within past 7 days (unless prothrombin time is < 1.2 times control)
Use cautiously in:
• patients receiving drugs that affect hemostasis (such as thrombolytics, anticoagulants, or antiplatelet drugs)
• pregnant or breastfeeding patients.
• I.V. bolus dose may be given undiluted. For I.V. infusion, further dilute the desired dose with normal saline or D5W.
• Give through separate I.V. line with no other drugs.
• Avoid noncompressible I.V. sites, such as subclavian or jugular vein.
☞ Stop continuous infusion after failed PCI.
• Restrict patient to bed rest for 6 to 8 hours after drug withdrawal or 4 hours after heparin withdrawal (whichever occurs first).
• After catheter removal, apply pressure to femoral artery for at least 30 minutes.
CNS: dizziness, anxiety, agitation, abnormal thinking, hypoesthesia, difficulty speaking, confusion, weakness, cerebral ischemia, coma
CV: pseudoaneurysm, palpitations, vascular disorders, arteriovenous fistula, hypotension, peripheral edema, weak pulse, intermittent claudication, bradycardia, ventricular or supraventricular tachycardia, atrial fibrillation or flutter, atrioventricular block, nodal arrhythmias, pericardial effusion, embolism, thrombophlebitis
EENT: abnormal or double vision
GI: nausea, vomiting, diarrhea, constipation, dyspepsia, ileus, gastroesophageal reflux, enlarged abdomen, dry mouth
GU: urinary tract infection, urine retention or urinary incontinence, painful or frequent urination, abnormal renal function, cystalgia, prostatitis Hematologic: anemia, leukocytosis, thrombocytopenia, bleeding
Metabolic: diabetes mellitus, hyperkalemia
Musculoskeletal: myopathy, myalgia, increased muscle tension, reduced muscle stretching ability
Respiratory: pneumonia, crackles, rhonchi, bronchitis, pleurisy, pleural effusion, bronchospasm, pulmonary edema, pulmonary embolism
Skin: pallor, cellulitis, petechiae, pruritus, bullous eruptions, diaphoresis
Other: abscess, peripheral coldness, development of human antichimeric antibodies
Drug-drug.Drugs that affect hemostasis (such as aspirin, dextran, dipyridamole, heparin, nonsteroidal anti-inflammatory drugs, oral anticoagulants, thrombolytics, and ticlopidine): increased bleeding risk
Drug-diagnostic tests.Activated partial thromboplastin time (APTT), clotting time, prothrombin time (PT): increased values
Platelets: decreased count
• Assess platelet count before, during, and after therapy.
☞ Monitor catheter insertion site frequently for bleeding.
☞ During catheter insertion and for 6 hours after catheter removal, frequently monitor digital pulse in leg where catheter was inserted.
• Monitor CBC, PT, APTT, and International Normalized Ratio.
• Minimize arterial or venous punctures, automatic blood pressure cuff use, I.M. injections, nasotracheal or nasogastric intubation, and urinary catheterization.
• Use indwelling venipuncture device, such as heparin lock, to draw blood.
• Tell patient what to expect during and after drug administration.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
☞ Instruct patient to immediately report unusual bleeding or bruising.
• Caution patient to avoid activities that may cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
• Inform patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.