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argatroban (Rx)Brand and Other Names:Acova

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 100mg/mL

ready-to-use injectable

  • 50mg/50mL 0.9% NaCl
  • 125mg/125mL 0.9% NaCl
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Thrombocytopenia

Indicated as an anticoagulant for prophylaxis or treatment of thrombosis in patients with heparin-induced thrombocytopenia

Initial: 2 mcg/kg/min IV continuous infusion over 1-3 hours until steady-state aPTT is 1.5-3 times initial baseline value 

Not to exceed infusion rate of 10 mcg/kg/min

Dosing considerations

  • Check aPTT and adjust dose until target aPTT is achieved

Percutaneous Coronary Intervention

Indicated as an anticoagulant in patients with or at risk for heparin-induced thrombocytopenia undergoing percutaneous coronary intervention (PCI)

Initial: 25 mcg/kg/min IV infusion, AND 

A bolus of 350 mcg/kg IV over 3-5 minutes via large-bore IV line

Check activated clotting time (ACT) 5-10 minutes after bolus dose is completed; procedure may proceed if ACT is >300 seconds

If ACT is <300 seconds, administer additional IV bolus dose of 150 mcg/kg, increase infusion dose to 30 mcg/kg/min, and check ACT 5-10 minutes later

If ACT >450 seconds, decrease infusion rate to 15 mcg/kg/min, and check ACT 5-10 minutes later

After therapeutic ACT (300-450 sec) achieved, continue this infusion dose for duration of procedure

Dosing Modifications

Hepatic impairment

  • Approximately 4-fold decrease in clearance relative to those with normal hepatic function, so dosing modification warranted; monitor aPTT and adjust dosage as clinically indicated
  • Thrombocytopenia: Decrease initial dose to 0.5 mcg/kg/min IV 
  • PCI: Avoid use in patients with clinically significant hepatic disease or AST/ALT levels >3 x ULN

Safety and efficacy not established

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Interactions

Interaction Checker

argatroban and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            GI bleeding (14%)

            Hematuria (12%)

            1-10%

            Chest pain (1-15%)

            Hemoglobin and hematocrit decrease (10%)

            Hypotension (7-10%)

            Dyspnea (8%)

            Fever (7%)

            Sepsis (6%)

            Cardiac arrest (6%)

            Diarrhea (6%)

            Nausea (5%)

            Groin hemorrhage (5%)

            Pain (5%)

            Urinary tract infection (5%)

            Ventricular tachycardia (5%)

            Bradyarrhythmia (4.5%)

            Infection (4%)

            Vomiting (2.6-4%)

            Intracranial hemorrhage (1-4%)

            Myocardial infarction (3.5%)

            Hemoptysis (3%)

            Nephrotoxicity (3%)

            Cough (3%)

            Atrial fibrillation (3%)

            Brachial hemorrhage (2%)

            Major GI hemorrhage (1-2%)

            Angina (1.8%)

            Coronary arterial hemorrhage (1.8%)

            Coronary artery thrombosis (1.8%)

            Frequency Not Defined

            Minor hematuria

            Pulmonary edema

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            Warnings

            Contraindications

            Hypersensitivity

            Active major bleeding

            Cautions

            Monitor therapy with aPTT

            Hemorrhagic diathesis, conditions that increase hemorrhage risk (eg, severe hypertension, major surgery, GI ulceration)

            Hepatic dysfunction

            Patients with illnesses that reduce clearance may require dose reduction

            Safety and efficacy of concomitant administration with thrombolytic agents not established

            Discontinue parenteral anticoagulant therapy prior to initiating treatment

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Unknown whether excreted in human breast milk; administer only if benefits greatly outweigh risks

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Competitive, direct thrombin inhibitor that reversibly binds to thrombin active site; thrombin enables fibrinogen conversion to fibrin during the coagulation cascade

            Distribution

            Protein bound: 54%

            Vd: 174 mL/kg

            Metabolism

            Liver

            Elimination

            Half-life: 39-51 min

            Total body clearance: 5.1 mL/kg/min

            Excretion: Feces (65%); urine (22%)

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            Administration

            IV Compatibilities

            Y-site

            • Atropine
            • Diltiazem
            • Diphenhydramine
            • Dobutamine
            • Dopamine
            • Fentanyl
            • Hydrocortisone succinate
            • Metoprolol
            • Midazolam
            • Morphine sulfate
            • Norepinephrine
            • Phenylephrine
            • Verapamil

            IV Preparation

            100 mg/mL injectable, dilute to final concentration of 1 mg/mL in NS, D5W, or LR

            Ready-to-use preparations (1 mg/mL) require no further dilution; vial may be inverted for use with an infusion set

            IV Administration

            See adult dosing for infusion rate

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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