EPTIFIBATIDE

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

Availability

0.75 mg/mL, 2 mg/mL injection

Action

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

Therapeutic Effect

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 wk; thrombocytopenia; renal failure requiring dialysis; coagulopathy; recent major surgery or trauma; intracranial neoplasm, intracranial bleeding within 6 mo; concurrent administration of another GPIIb/IIIa receptor inhibitor (e.g., abciximab); 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 (max: 22.6 mg) followed by 2 mcg/kg/min until hospital discharge or up to 72 h Percutaneous Coronary Interventions (PCI) Adult: IV 180 mcg/kg initial bolus followed by 2 mcg/kg/min; after 10 min, a second 180 mcg/kg bolus should be given; the infusion should continue up to 24 h after the end of the procedure Renal Impairment If Clcr 10–49 mL/min, then give 1 mcg/kg/min continuous infusion.

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. Metabolism: Minimally metabolized. Elimination: 50% 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