eptifibatide

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.

See 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.