Baxter s presentation of eptifibatide is the first of its kind available in a flexible container. Glycoprotein iibiiia inhibitors in patients with renal. Esprit was a randomized, placebocontrolled trial that evaluated the use of eptifibatide in elective pci. About 50% of the total body clearance of eptifibatide occurs via renal mechanisms. One patient with acute renal insufficiency had prolonged inhibition. Eptifibatide is a glycoprotein iibiiia class platelet inhibitor drug used to. Across all dosing groups, no significant reductions were found in ischemic end points between early versus delayed provisional eptifibatide or 1.
We report on our experience with the intraarterial administration of eptifibatide for thrombolysis during aneurysmembolization procedures. Integrilin eptifibatide dose, indications, adverse effects. May administer eptifibatide in the same intravenous line as alteplase, atropine, dobutamine, heparin, lidocaine, meperidine, metoprolol, midazolam, morphine, nitroglycerin, or verapamil. Australian injectable drugs handbook 8th edition march 2020 update 225. Withdraw the bolus dose s of integrilin from the 10ml vial into a syringe. Gp iibiiia inhibitor adult cardiology treatment dosing. Aug 24, 2020 renal dose adjustments acute coronary syndrome crcl less than 50 mlmin or serum creatinine greater than 2.
Of these, % received adjusted dose eptifibatide and 6% received an excess dose. A model of dosing agreement among various methods of estimating creatinine clearance martha f healy, karen gabel speroni, kenneth r eugenio, patricia m murphy, 2012 intended for healthcare professionals. When using an intravenous infusion pump, administer integrilin undiluted directly from the 100ml vial. Eptifibatide is cleared by both renal and non renal mechanisms, and renal clearance accounts for about 40% of total body clearance 21. Abciximab cost per day calculated for bolus dose and 12hour infusion. Nov 01, 2019 may administer integrilin in the same iv line with 0. Use in patients with more severe renal impairment is contraindicated. Eptifibatide in acute coronary syndrome digital commons. The recommended adult dosage of eptifibatide in patients with normal renal function is an intravenous bolus of 180 gkg administered immediately before the initiation of pci followed by a continuous infusion of 2. Renal abciximab can be found on circulating platelets up to 15 days postinfusion. In patients with significant renal impairment associated with a crcl 2 mgdl, if estimated crcl is not available, the dose of eptifibatide should be reduced.
Dose adjustments do not appear to be necessary for patients with mild to moderate renal impairment i. The information on dosage adjustments in renal impairment given in this. In patients with moderate or severe renal impairment, clearance rates and steadystate concentrations of eptifibatide were respectively about 50% lower and. An appropriate eptifibatide dose was defined as a physician order for a continuous infusion of 1 mcg per kg per minute in patients with an estimated crcl results. Vincent hospitalindianapolis from january 1, 2011 through december 31, 2012. Assessment of eptifibatide clearance by hemodialysis using an in. When using an intravenous infusion pump, administer integrilinundiluted directly from the 100ml vial. Eptifibatide 274 erlotinib 275 ertapenem 276 erythromycin 277 escitalopram 279. With either vehicle, the infusion may also contain up to 60 meql of potassium chloride. Abciximab is not renally eliminated and does not require dosage adjustment in ri. Gp iibiiia inhibitor adult cardiology treatment dosing and monitoring guidelines during times of eptifibatide shortage, the following guidance is available for tirofiban use. Severe renal dysfunction prolongs the duration of action of eptifibatide, as has been shown in three patients 22. Local intraarterial eptifibatide for intraoperative.
A novel dosing regimen was suggested for eptifibatide in planned coronary stent. Renal impairment in patients with moderate renal impairment creatinine clearance. Withdraw the bolus dose s of eptifibatide injection from the 10ml vial into a syringe. Local intraarterial eptifibatide for intraoperative vessel. To assess the impact of education on physician adherence to the renal dosing recommendation for eptifibatide at 2 academic medical centers. Inspect eptifibatide for particulate matter and discoloration prior to administration, whenever solution and container permit. Eptifibatide injection is a clear, colorless, sterile, nonpyrogenic solution for intravenous infusion with an empirical formula of c 35 h 49 n 11 o 9 s 2 and a molecular weight of 831. Highlights of prescribing information eptifibatide injection. Withdraw the bolus dose s of integrilinfrom the 10ml vial into a syringe.
Dailymed integrilin eptifibatide injection, solution. Highlights of prescribing information coadministration of. Eptifibatide integrilin tirofiban aggrastat dosing acsii. Hospital pharmacists are unsung heroes working behind the scenes to make sure every dose of medication is delivered accurately and ontime to patients, said robert felicelli, president. Sex, age, weight, height, serum creatinine, and estimated glomerular filtration rate egfr were obtained retrospectively from the records of patients who. Clinical and economic studies of eptifibatide in coronary. Aug 02, 2011 integrilin is cleared in part by the kidney and its plasma concentrations are doubled in patients with renal disease creatinine clearance dose of integrilin needs to be reduced to 1 mcgkgmin in these patients. Eptifibatide is a small peptide that was approved by the us food and drug administration in 1998. The cockcroftgault cg equation is used for pharmacokinetic studies and drug dosage adjustments, but the modi. Minimize invasive procedures, including venous punctures and im injections. When using an intravenous infusion pump, administer integrilin undiluted directly. Highlights of prescribing information eptifibatide. Before infusion of integrilin, the following laboratory tests should be performed to identify preexisting hemostatic abnormalities. We administered eptifibatide 1015 mg through a microcatheter proximal to the thrombus.
Eptifibatide was associated with a significant reduction in the incidence of death or myocardial infarction at 96 hours, 7 days, and 30 days. Eptifibatide is eliminated via renal excretion, so dose adjustment is recommended with a creatinine clearance of less than 50 mlmin 2,64. Eptifibatide is cleared by both renal and nonrenal mechanisms, with renal clearance accounting for approximately 40% of total body clearance. May administer integrilin in the same iv line with 0. Should be used with extreme caution in patients with renal dysfunction, dosage adjustment is required. Infusion should be continued until hospital discharge, or for up to 18 to 24 hours, whichever comes first. Derived from a protein found in the venom of the southeastern pygmy rattlesnake, sistrurus miliarus barbouri, eptifibatide is an anticoagulant that. Comparison of drug dosing recommendations based on. Switching from eptifibatide to tirofiban use in acs. Assessment of eptifibatide dosing in renal impairment before. Immediately following the bolus dose administration, initiate a continuous infusion of integrilin. Specifically, eptifibatide is contraindicated and tirofiban is not defined in patients undergoing dialysis. In meylers side effects of drugs sixteenth edition, 2016. Feb 26, 2015 if you have moderate renal dysfunction, dosing of these agents must be adjusted, and if you have severe renal dysfunction, then tirofiban and eptifibatide should probably not be used at all.
Although contraindicated in dialysis patients due to limited safety and. There was a strong correlation between eptifibatide clearance and creatinine clearance, and the break point for the purpose of dosage adjustment was a creatinine clearance of 56 mlminute. This book is distributed under the terms of the creat. The total drug clearance of eptifibatide is reduced by 50% in patients with crcl eptifibatide is a cyclic heptapeptide containing six amino acids and one mercaptopropionyl desamino cysteinyl residue. This recommendation is based on pharmacodynamic and pharmacokinetic data.
Assessment of eptifibatide dosing in renal impairment. May administer eptifibatide injection in the same iv line with 0. Find patient medical information for eptifibatide intravenous on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Despite being contraindicated in dialysis, eptifibatide was used. Safety and efficacy of adjusteddose eptifibatide in patients. The book provides essential information on drug dosing in patients with. In 4 cases 3 stentassisted coiling procedures and 1 with posthemorrhagic vasospasm, we noted the formation of thrombus occluding a vessel. A novel dosing regimen was suggested for eptifibatide in planned coronary stent implantation. Fda approval and launch of readytouse eptifibatide. Reduce the rate to 1 microgramkgminute in renal impairment.
Eptifibatide is a cyclic heptapeptide containing six amino acids and one mercaptopropionyl desamino cysteinyl residue. Gp iibiiia inhibitor adult cardiology treatment dosing and. The first major clinical trial of eptifibatide, impactii integrilin to minimize platelet aggregation and coronary thrombosisii, did not show improvement in clinical outcomes due to use of a lower bolus dose 5. It is approximately 25% bound to human plasma protein, with a volume of distribution of 0. The authors concluded that in patients with renal impairment infusion doses. Paediatric population eptifibatide is not recommended for use in children and adolescents below 18 years of age, due to a lack of. A total of 148 patients with renal impairment who received eptifibatide were evaluated 106 in the preeducation phase and 42 in the posteducation phase. Dosing guidelines book dosing guidelines for children dosing guidelines for adults. Consider assessment if clinical circumstances suggest overanticoagulation eg.
Integrilin eptifibatide dose, indications, adverse. Safety and efficacy of adjusteddose eptifibatide in. Methods after irb approval, we performed a historical cohort study which included all adult cardiology patients with serum creatinine of 1. The total drug clearance of eptifibatide is reduced by 50% in patients with crcl eptifibatide integrilin. Eptifibatide indications, pharmacology, dosage, side. The role of the nurse in treating patients with integrilin. Guidelines for use of fondaparinux anticoagulation services. May 01, 2001 integrilin eptifibatide injection is a clear, colorless, sterile, nonpyrogenic solution for intravenous iv use. Dosing guidelines book school of medicine university of. In clinical trials, incidence of bleeding complications was higher in the elderly in both placebo and eptifibatide groups, and the incremental risk of eptifibatide associated bleeding was greater in the older patients. Eptifibatide is a synthetic homodetic cyclic peptide comprising nalpha3sulfanylpropanoylhomoarginyl, glycyl, aspartyl, tryptophyl, prolyl and cysteinamide residues connected in sequence and cyclised via a disulfide bond.
Guidelines for the use of eptifibatide integrilin in acute. The available clinical evidence cannot however confirm that this dose modification results in a preserved benefit. May 24, 2018 the recommended adult dosage of eptifibatide in patients with acute coronary syndrome and normal renal function is an intravenous bolus of 180 gkg as soon as possible following diagnosis, followed by a continuous infusion of 2. In patients with moderate to severe renal insufficiency crcl eptifibatide is reduced by approximately 50% and steadystate plasma levels approximately doubled see use in specific populations 8. Eptifibatide injection is a refrigerated, premixed, sterile, nonpyrogenic single dose solution packaged in. Pletal cilostazol dose, indications, adverse effects.
An appropriate eptifibatide dose was defined as a physician order for a continuous infusion of 1 mcg per kg per minute in patients with an estimated crcl less than 50 ml per minute. Apr 02, 2014 a total of 10,948 patients were randomized. To compare hypothetical renal dosing adjustments of eptifibatide using both the recommended method and several other commonly used formulas for estimating kidney function. Presentation number 43 inappropriate dosing of eptifibatide. Tirofiban and eptifibatide are renally cleared and thus must have dosage adjustment if used in patients with renal insufficiency ri. The primary outcome measure was the proportion of patients with renal impairment dosed appropriately with eptifibatide before and after inservice education provided by a clinical pharmacist. The information on dosage adjustments in renal impairment given in this book is based on cockcroftgault creatinine clearance and not egfr, since the majority. Sep 06, 2017 the recommended adult dosage of eptifibatide in patients with normal renal function is an intravenous bolus of 180 gkg administered immediately before the initiation of pci followed by a continuous infusion of 2. The renal drug handbook welcome to the st georges hospital. Bleeding has been associated with worse outcomes after pci and is the major risk associated with the use of gpras.
A catalogue record for this book is available from the british library. Eptifibatide has linear, dose proportional pharmacokinetics and steady state is achieved within 46 hours. Mwlcems system continuing education packet eptifibatide. The comparative safety of abciximab versus eptifibatide in patients. Integrilin eptifibatide dosing, indications, interactions. Each 10ml vial contains 2 mgml of eptifibatide and each 100ml vial contains either 0.
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