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ABCIXIMAB

Medical Diagnosis and Drugs, Medications
ABCIXIMAb
(ab-cix ' i-mab)
ReoPro
Classifications: platelet aggregation inhibitor; glycoprotein iib/iiia inhibitor; antithrombotic;
Therapeutic:platelet aggregation inhibitor; antithrombotic
Pregnancy Category: C

Availability

2 mg/mL in 5 mL vials

Action

Abciximab is a human–murine monoclonal antibody Fab (fragment antigen binding) fragment that binds to the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor sites of platelets.

Therapeutic Effect

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

Uses

Adjunct to aspirin and heparin for the prevention of acute cardiac ischemic complications in patients undergoing percutaneous transluminal coronary angioplasty (PTCA).

Contraindications

Hypersensitivity to abciximab or to murine proteins; active internal bleeding; GI or GU bleeding within 6 wk; history of CVA within 2 y or a CVA with severe neurologic deficit; administration of oral anticoagulants unless PT <1.2 times control; thrombocytopenia (<100,000 cells/mL); recent major surgery or trauma; intracranial neoplasm, aneurysm, severe hypertension; history of vasculitis; use of dextran before or during PTCA; pregnancy (category C); lactation.

Cautious Use

Patients weighing <75 kg; older adults; history of previous GI disease; recent thrombolytic therapy; PTCa within 12 h of MI; unsuccessful PTCA; PTCA procedure lasting >70 min.

Route & Dosage

PTCA
Adult: IV 10–60 min prior to angioplasty, 0.25 mg/kg bolus over 5 min followed by continuous infusion of 0.125 mcg/kg/min (up to 10 mcg/min) for next 12 h

Administration

Intravenous
  • Do not shake vial. Discard if visible opaque particles are noted.
  • Use a nonpyrogenic low protein-binding 0.2- or 0.22-μm filter when withdrawing drug into a syringe from the 2 mg/mL vial and when infusing as continuous IV.

PREPARE: Direct: No dilution required.  Continuous: Inject 5 mL of drug into 250 mL of NS or D5W.  

ADMINISTER: Direct: Give undiluted bolus dose over 5 min.  Continuous: Infuse at no more than 15 mL/h (10 mcg/min) via an infusion pump; add no other drugs to the solution or IV line.  

INCOMPATIBILITIES Solution/additive: Infuse through separate IV line. Y-site: Infuse through separate IV line.

  • Discard any unused drug at the end of the 12-h infusion as well as any unused portion left in vial.
  • Store vials at 2°–8° C (36°–46° F).

Adverse Effects (≥1%)

Hematologic: Bleeding, including intracranial, retroperitoneal, and hematemesis; thrombocytopenia.

Interactions

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

Pharmacokinetics

Onset: >90% inhibition of platelet aggregation within 2 h. Duration: Approximately 48 h. Half-Life: 30 min.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of: bleeding at all potential sites (e.g., catheter insertion, needle puncture, or cutdown sites; GI, GU, or retroperitoneal sites); hypersensitivity that may occur any time during administration.
  • Lab tests: Monitor Hgb, Hct, platelet count, PT, APTT, INR, and activated clotting time, every 2–4 h during first 24 h.
  • Avoid or minimize unnecessary invasive procedures and devices to reduce risk of bleeding.
  • Elevate head of bed ≤30° and keep limb straight when femoral artery access is used; following sheath removal, apply pressure for 30 min.
  • Stop infusion immediately and notify physician if bleeding or S&S of hypersensitivity occurs.

Patient & Family Education

  • Report any S&S of bleeding immediately.

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

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