EPTIFIBATIDE
(ep-ti-fib'a-tide)
Integrilin
Classifications: cardiovascular agent; antithrombotic agent; antiplatelet antibody; glycoprotein iib/iiia inhibitor
Prototype: Abciximab
Pregnancy Category: B

Availability

0.75 mg/mL, 2 mg/mL injection

Actions

Binds to the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor sites of platelets.

Therapeutic Effects

Inhibits platelet aggregation by preventing fibrinogen, von Willebrand's factor, and other molecules from adhering to GPIIb/IIIa receptor sites on platelets.

Uses

Treatment of acute coronary syndromes (unstable angina, non-Q-wave MI) and patients undergoing percutaneous coronary interventions (PCIs).

Contraindications

Hypersensitivity to eptifibatide; active bleeding; GI or GU bleeding within 6 weeks; thrombocytopenia; recent major surgery or trauma; intracranial neoplasm, intracranial bleeding within 6 mo; concurrent administration of another GPIIb/IIIa receptor inhibitor (e.g., abciximab); renal dialysis; severe hypertension (systolic blood pressure >200 mm Hg or diastolic blood pressure >110 mm Hg), aneurysm.

Cautious Use

Hypersensitivity to related compounds (e.g., abciximab, tirofiban, lamifiban); concurrent administration of other anticoagulants; pregnancy (category B), lactation. Safety and effectiveness in children are not established.

Route & Dosage

Acute Coronary Syndromes (ACS)
Adult: IV 180 mcg/kg initial bolus followed by 2 mcg/kg/min until hospital discharge or up to 72 h

PCI in Patients with ACS
Adult: IV 180 mcg/kg initial bolus followed by 0.5 mcg/kg/min for 20–24 h after end of procedure

PCI in Patients without ACS
Adult: IV 135 mcg/kg initial bolus followed by 0.5 mcg/kg/min for 20–24 h after end of procedure

Administration

Note: Review contraindications to administration prior to giving this drug.

Intravenous

PREPARE: Direct: Give undiluted.

ADMINISTER: Direct: Give bolus doses IV push over 1–2. Continuous: Start continuous infusion immediately following bolus dose. Give undiluted directly from the 100-mL vial (at a rate based on patient's weight) using a vented infusion set. May be given in the same IV line with NS or D5/NS (either solution may contain up to 60 mEq KCl).

Store unopened vials at 2°–8° C (36°–46° F) and protect from light. Discard any unused portion in opened vial.

Adverse Effects (1%)

CNS: Intracranial bleed (rare). GI: GI bleeding. Hematologic: Bleeding (major bleeding 4.4–11%), anemia, thrombocytopenia.

Interactions

Drug: oral anticoagulants, nsaids, dipyridamole, ticlopidine, dextran may increase risk of bleeding.

Pharmacokinetics

Duration: 6–8 h after stopping infusion. Distribution: 25% protein bound. Metabolism: Minimally metabolized. Elimination: 50% excreted in urine. Half-Life: 2.5 h.

Nursing Implications

Assessment & Drug Effects

Lab tests: Prior to infusion determine PT/aPTT & INR, ACT for those undergoing percutaneous coronary intervention (PCI); Hct or Hgb; platelet count; and serum creatinine.
Lab tests: Monitor aPTT & INR (target aPPT, 50–70 s); during PCI (target ACT, 300–350 s).
Minimize all vascular and other trauma during treatment. When obtaining IV access, avoid using a noncompressible site such as the subclavian vein.
Monitor carefully for and immediately report S&S of bleeding (e.g., femoral artery access site bleeding, intracerebral hemorrhage, GI bleeding).
Immediately stop infusion of eptifibatide and heparin if bleeding at the arterial access site cannot be controlled by pressure.
Achieve hemostasis at the arterial access site by standard compression for a minimum of 4 h prior to hospital discharge following discontinuation of eptifibatide and heparin.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug