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Eptifibatide (Integrilin)
( ep-tih- FY-beh-tide)
Pregnancy Category: B Integrilin (Rx)

Classification: Drug for acute coronary syndrome

Action/Kinetics: Reversibly inhibits platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor, and other adhesive ligands to GP IIb/IIIa. Immediately effective after IV use. t 1/2, elimination: 2.5 hr. Drug and metabolites are excreted through kidneys.

Uses: Treatment of acute coronary syndrome, including those to be managed medically and those undergoing percutaneous coronary intervention. Treatment of those undergoing percutaneous coronary intervention and not presenting with acute coronary syndrome.

Contraindications: History of bleeding diathesis or evidence of active abnormal bleeding within the past 30 days. Severe hypertension (systolic BP > 200 mm Hg or diastolic BP > 110 mm Hg) inadequately controlled. Major surgery within the past 6 weeks, history of stroke within 30 days or any history of hemorrhagic stroke, current or planned use of another parenteral GP IIb/IIIa inhibitor, platelet count less than 100,000/mm 3, dependency on renal dialysis. Serum creatinine of 2.0 mg/dL or more (for the 180 üg/kg bolus and the 2 üg/kg/min infusion) or 4.0 mg/dL or more (for the 135 üg/kg bolus and the 0.5 üg/kg/min infusion). Lactation.

Special Concerns: Bleeding is the most common complication; there is a greater risk in older clients. Use with caution when used with other drugs that affect hemostasis, including thrombolytics, oral anticoagulants, NSAIDs, dipyridamole, ticlopidine, and clopidogrel. Use with caution during lactation. Safety and efficacy have not been determined in children.

Side Effects: CV: Major bleeding, including intracranial hemorrhage, bleeding from the femoral artery access site, and bleeding that leads to decreases in hemoglobin greater than 5 g/dL. Minor bleeding, including spontaneous gross hematuria, spontaneous hematemesis, or blood loss with a hemoglobin decrease of more than 3 g/dL. Oropharyngeal (especially gingival), genitourinary, GI, and retroperitoneal bleeding. Hypotension. Hypersenstivity/allergy: Anaphylaxis other allergic symptoms.

Drug Interactions: Possible additive effects when used with thrombolytics, anticoagulants, or other antiplatelet drugs. Evening primrose oil / Potential for antiplatelet effect Feverfew / Potential for antiplatelet effect Garlic / Potential for antiplatelet effect Ginger / Potential for antiplatelet effect Ginkgo biloba / Potential for antiplatelet effect Ginseng / Potential for antiplatelet effect Grapeseed extract / Potential for antiplatelet effect

How Supplied: Injection: 0.75 mg/mL, 2 mg/mL

?IV Acute coronary syndrome.
Adults, inital: IV bolus of 180 üg/kg as soon as possible following diagnosis, followed by a continuous infusion of 2 üg/kg/min until hospital discharge or initiation of coronary artery bypass surgery, up to 72 hr. If percutaneous coronary intervention will be undertaken, consider decreasing the infusion rate to 0.5 üg/kg/min at the time of the procedure. Continue the infusion for an additional 20-24 hr after the procedure, allowing for up to 96 hr of therapy. Clients weighing > 121 kg have received a maximum bolus of 22.6 mg (11.3 mL of the 2 mg/mL injection) followed by a maximum rate of 15 mg (20 mL of the 0.75 mg/mL injection)/hr.
Percutaneous coronary intervention in those not presenting with acute coronary syndrome.
Adults, initial: IV bolus of 135 üg/kg immediately before the initiation of PCI followed by a continuous infusion of 0.5 üg/kg/min for 20-24 hr.

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