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tirofiban (Rx)Brand and Other Names:Aggrastat

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

premixed infusion solution

  • 5mg/100mL (50mcg/mL)
  • 12.5mg/250mL (50mcg/mL)
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Non-ST Elevated Acute Coronary Syndrome

Indicated to reduce the rate of thrombotic cardiovascular events (combined endpoint of death, myocardial infarction, or refractory ischemia/repeat cardiac procedure) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS)

Loading dose: 25 mcg/kg IV infused within 5 min, THEN

Post loading dose infusion: 0.15 mcg/kg/min IV for up to 18 hr 

Refer to prescribing information for dosing chart by weight and CrCl

Renal Impairment

CrCl ≤60 mL/min: Decrease post loading dose infusion by 50% to 0.075 mcg/kg/min IV 

Safety and efficacy not established

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Interactions

Interaction Checker

tirofiban 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%

            Bleeding, minor (11%)

            1-10%

            Pelvic pain (6%)

            Coronary artery dissection (5%)

            Bradycardia (4%)

            Dizziness (3%)

            Lower extremity pain (3%)

            Edema (2%)

            Sweating (2%)

            Bleeding, major (1-2%)

            Thrombocytopenia (1.5%)

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            Warnings

            Contraindications

            Hypersensitivity, history of thrombocytopenia with tirofiban

            Active/history of internal bleeding (within last 30 days), intracranial hemorrhage or neoplasm

            History of stroke within last 30 days or any history of hemorrhagic stroke

            AV malformation or aneurysm, aortic dissection, severe HTN, acute pericarditis

            Current use of another parenteral glycoprotein IIb/IIIa inhibitor

            Cautions

            Platelets <150,000/cu.mm, hemorrhagic retinopathy, chronic HD

            Rates of major bleeds with the recommended high-dose bolus (ie, 25 mcg/kg/min loading dose) were consistent with the rates observed in the PRISM-PLUS regimen (original dosage regimen); there was a trend toward greater bleeding in ST segment elevation myocardial infarction (STEMI) patients treated with fibrinolytics prior to administration tirofiban using the high-dose bolus during rescue PCI

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: not known if excreted in breast milk, nursing not a priority in ACS pts

            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

            Blocks binding of fibrinogen and von Willebrand factor to glycoprotein IIb/IIIa receptor on platelet surface; inhibits platelet aggregation

            Pharmacokinetics

            Half-life: 2 hr

            Duration: 4 hr

            Protein bound: 65%

            Vd: 22-42 L

            Clearance: 213-314 mL/min

            Excretion: Urine (65%); feces (25%)

            Dialyzable: Yes

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            Administration

            IV Incompatibilities

            Y-site: diazepam

            IV Compatibilities

            Solution: D5W, D5/½NS, NS

            Y-site: amiodarone, atropine, bivalirudin, dobutamine, dopamine, epinephrine, famotidine, furosemide, heparin, lidocaine, midazolam, morphine, nitroglycerin, KCl, propranolol

            IV Preparation

            Available only as premixed 50 mcg/mL solution for injection (100 mL or 250 mL bags)

            IV Administration

            See adult dosing for infusion rate

            Storage

            Store at 25°C (77°F) with excursions permitted between 15-30°C (59-86°F)

            Do not freeze

            Protect from light during storageIV IncompatibilitiesY-site: diazepamIV CompatibilitiesSolution: D5W, D5/½NS, NSY-site: amiodarone, atropine, bivalirudin, dobutamine, dopamine, epinephrine, famotidine, furosemide, heparin, lidocaine, midazolam, morphine, nitroglycerin, KCl, propranololIV PreparationAvailable only as premixed 50 mcg/mL solution for injection (100 mL or 250 mL bags)IV AdministrationSee adult dosing for infusion rateStorageStore at 25°C (77°F) with excursions permitted between 15-30°C (59-86°F)Do not freezeProtect from light during storage

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            Images

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            Formulary

            FormularyPatient Discounts

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            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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