argatroban (Rx)

Brand and Other Names:Acova
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 100mg/mL

ready-to-use injectable

  • 50mg/50mL 0.9% NaCl
  • 125mg/125mL 0.9% NaCl
  • 250mg/2.5mL 0.9% NaCl

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: For patients with hepatic impairment undergoing PCI and who have HIT or are at risk for HIT, carefully titrate argatroban until desired level of anticoagulation achieved; use of drug in PCI patients with clinically significant hepatic disease or AST/ALT levels ≥3 times the upper limit of normal should be avoided

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and argatroban

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            Contraindicated (3)

            • defibrotide

              defibrotide increases effects of argatroban by pharmacodynamic synergism. Contraindicated. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. This does not include use for routine maintenance or reopening of central venous lines.

            • mifepristone

              mifepristone, argatroban. Other (see comment). Contraindicated. Comment: Mifepristone may lead to excessive post abortion bleeding in pts. on anticoagulant therapy.

            • prothrombin complex concentrate, human

              argatroban, prothrombin complex concentrate, human. pharmacodynamic antagonism. Contraindicated.

            Serious - Use Alternative (62)

            • abciximab

              argatroban, abciximab. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • amobarbital

              amobarbital decreases effects of argatroban by increasing metabolism. Avoid or Use Alternate Drug.

            • anagrelide

              argatroban, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • antithrombin alfa

              antithrombin alfa and argatroban both increase anticoagulation. Avoid or Use Alternate Drug.

            • antithrombin III

              antithrombin III and argatroban both increase anticoagulation. Avoid or Use Alternate Drug.

            • apixaban

              argatroban and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • azithromycin

              azithromycin increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

            • bazedoxifene/conjugated estrogens

              bazedoxifene/conjugated estrogens decreases effects of argatroban by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • bemiparin

              argatroban and bemiparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • bivalirudin

              argatroban and bivalirudin both increase anticoagulation. Avoid or Use Alternate Drug.

            • butabarbital

              butabarbital decreases effects of argatroban by increasing metabolism. Avoid or Use Alternate Drug.

            • butalbital

              butalbital decreases effects of argatroban by increasing metabolism. Avoid or Use Alternate Drug.

            • cefamandole

              cefamandole increases effects of argatroban by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • cefazolin

              cefazolin increases effects of argatroban by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • cefdinir

              cefdinir increases effects of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • cefditoren

              cefditoren will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cefotetan

              cefotetan increases effects of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity.

            • cefoxitin

              cefoxitin will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cefpodoxime

              cefpodoxime will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • ceftriaxone

              ceftriaxone will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cefuroxime

              cefuroxime will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • cilostazol

              argatroban, cilostazol. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • clarithromycin

              clarithromycin increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

            • clopidogrel

              argatroban, clopidogrel. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • conjugated estrogens

              conjugated estrogens decreases effects of argatroban by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • dalteparin

              argatroban and dalteparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • dipyridamole

              argatroban, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • edoxaban

              edoxaban, argatroban. Either increases toxicity of the other by anticoagulation. Avoid or Use Alternate Drug. Both drugs have the potential to cause bleeding, monitor closely. Promptly evaluate any signs or symptoms of blood loss. Long-term concomitant treatment with edoxaban and other anticoagulants is not recommended. Short-term coadministration may be needed for patients transitioning to or from edoxaban.

            • enoxaparin

              argatroban and enoxaparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • eptifibatide

              argatroban, eptifibatide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • erythromycin base

              erythromycin base increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              erythromycin lactobionate increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

            • erythromycin stearate

              erythromycin stearate increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

            • estradiol

              estradiol decreases effects of argatroban by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • estrogens conjugated synthetic

              estrogens conjugated synthetic decreases effects of argatroban by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • estropipate

              estropipate decreases effects of argatroban by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • Factor X, human

              argatroban will decrease the level or effect of Factor X, human by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Based on the mechanism of action, Factor X is likely to be counteracted by direct and indirect Factor Xa inhibitors.

            • fondaparinux

              argatroban and fondaparinux both increase anticoagulation. Avoid or Use Alternate Drug.

            • heparin

              argatroban and heparin both increase anticoagulation. Avoid or Use Alternate Drug.

            • levonorgestrel intrauterine

              levonorgestrel intrauterine, argatroban. Either decreases effects of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of thromboembolic disorders.

            • levonorgestrel oral

              levonorgestrel oral, argatroban. Either decreases effects of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Risk of thromboembolic disorders.

            • levothyroxine

              levothyroxine increases effects of argatroban by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • liothyronine

              liothyronine increases effects of argatroban by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • mestranol

              mestranol decreases effects of argatroban by pharmacodynamic antagonism. Contraindicated. Risk of thromboembolic disorders.

            • pentobarbital

              pentobarbital decreases effects of argatroban by increasing metabolism. Avoid or Use Alternate Drug.

            • phenindione

              argatroban and phenindione both increase anticoagulation. Avoid or Use Alternate Drug.

            • phenobarbital

              phenobarbital decreases effects of argatroban by increasing metabolism. Avoid or Use Alternate Drug.

            • piperacillin

              piperacillin will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

            • primidone

              primidone decreases effects of argatroban by increasing metabolism. Avoid or Use Alternate Drug.

            • protamine

              argatroban and protamine both increase anticoagulation. Avoid or Use Alternate Drug.

            • quinine

              quinine increases effects of argatroban by unknown mechanism. Avoid or Use Alternate Drug.

            • roxithromycin

              roxithromycin increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

            • secobarbital

              secobarbital decreases effects of argatroban by increasing metabolism. Avoid or Use Alternate Drug.

            • sulfadiazine

              sulfadiazine increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfadiazine increases effects of argatroban by plasma protein binding competition. Avoid or Use Alternate Drug.

            • sulfamethoxazole

              sulfamethoxazole increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfamethoxazole increases effects of argatroban by plasma protein binding competition. Avoid or Use Alternate Drug.

            • sulfisoxazole

              sulfisoxazole increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

              sulfisoxazole increases effects of argatroban by plasma protein binding competition. Avoid or Use Alternate Drug.

            • thyroid desiccated

              thyroid desiccated increases effects of argatroban by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • tibolone

              tibolone increases effects of argatroban by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • ticlopidine

              argatroban, ticlopidine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • tirofiban

              argatroban, tirofiban. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • warfarin

              argatroban and warfarin both increase anticoagulation. Avoid or Use Alternate Drug.

            Monitor Closely (122)

            • acalabrutinib

              acalabrutinib increases effects of argatroban by anticoagulation. Use Caution/Monitor. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding.

            • aceclofenac

              argatroban and aceclofenac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • acemetacin

              argatroban and acemetacin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • agrimony

              argatroban and agrimony both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alfalfa

              argatroban and alfalfa both increase anticoagulation. Modify Therapy/Monitor Closely.

            • alteplase

              argatroban and alteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • American ginseng

              argatroban and American ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • anamu

              argatroban and anamu both increase anticoagulation. Use Caution/Monitor.

            • aspirin

              argatroban and aspirin both increase anticoagulation. Modify Therapy/Monitor Closely.

              aspirin, argatroban. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • aspirin rectal

              argatroban and aspirin rectal both increase anticoagulation. Modify Therapy/Monitor Closely.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, argatroban. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

              argatroban and aspirin/citric acid/sodium bicarbonate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • azapropazone

              azapropazone increases effects of argatroban by plasma protein binding competition. Use Caution/Monitor.

            • azathioprine

              azathioprine decreases effects of argatroban by unknown mechanism. Use Caution/Monitor.

            • azficel-T

              azficel-T, argatroban. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.

            • betrixaban

              argatroban, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • budesonide

              budesonide, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • capecitabine

              capecitabine increases effects of argatroban by unspecified interaction mechanism. Use Caution/Monitor.

            • caplacizumab

              caplacizumab, argatroban. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            • carbamazepine

              carbamazepine decreases levels of argatroban by increasing metabolism. Use Caution/Monitor.

            • celecoxib

              argatroban and celecoxib both increase anticoagulation. Modify Therapy/Monitor Closely.

            • chitosan

              chitosan increases effects of argatroban by Other (see comment). Use Caution/Monitor. Comment: Chitosan can decrease GI absorption of vitamin K, enhancing anticoagulant effects.

            • choline magnesium trisalicylate

              argatroban and choline magnesium trisalicylate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cinnamon

              argatroban and cinnamon both increase anticoagulation. Modify Therapy/Monitor Closely.

            • citalopram

              citalopram increases effects of argatroban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

            • collagenase clostridium histolyticum

              argatroban increases toxicity of collagenase clostridium histolyticum by anticoagulation. Use Caution/Monitor. Collagenase clostridium histolyticum has high incidence of ecchymosis/contusion at injection site; avoid concomitant anticoagulants (except for low-dose aspirin, ie, up to 150 mg/day).

            • conjugated estrogens, vaginal

              conjugated estrogens, vaginal decreases effects of argatroban by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Risk of thromboembolic disorders.

            • cordyceps

              argatroban and cordyceps both increase anticoagulation. Modify Therapy/Monitor Closely.

            • cornsilk

              cornsilk decreases effects of argatroban by pharmacodynamic antagonism. Use Caution/Monitor. Cornsilk contains vitamin K; consume a consistent amount daily.

            • cortisone

              cortisone, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • cyclophosphamide

              cyclophosphamide increases effects of argatroban by unknown mechanism. Use Caution/Monitor. Additive risk of bleeding may be seen in thrombocytopenic patients receiving antineoplastic agents in combination with argatroban because these agents can decrease platelet counts.

            • dabigatran

              argatroban and dabigatran both increase anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

            • danshen

              argatroban and danshen both increase anticoagulation. Use Caution/Monitor.

            • deferasirox

              deferasirox, argatroban. Other (see comment). Use Caution/Monitor. Comment: Gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including anticoagulants.

            • deflazacort

              deflazacort, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • devil's claw

              argatroban and devil's claw both increase anticoagulation. Use Caution/Monitor.

            • dexamethasone

              dexamethasone, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • diclofenac

              argatroban and diclofenac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • diflunisal

              argatroban and diflunisal both increase anticoagulation. Modify Therapy/Monitor Closely.

              diflunisal increases effects of argatroban by plasma protein binding competition. Use Caution/Monitor.

            • dong quai

              argatroban and dong quai both increase anticoagulation. Modify Therapy/Monitor Closely.

            • epoprostenol

              argatroban and epoprostenol both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ethanol

              ethanol increases effects of argatroban by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

            • ethotoin

              argatroban increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, argatroban. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • etodolac

              argatroban and etodolac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenbufen

              argatroban and fenbufen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fennel

              argatroban and fennel both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fenoprofen

              argatroban and fenoprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • feverfew

              argatroban and feverfew both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fish oil

              fish oil, argatroban. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of argatroban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

            • fludrocortisone

              fludrocortisone, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • fluorouracil

              fluorouracil increases effects of argatroban by unspecified interaction mechanism. Use Caution/Monitor. Due to the thrombocytopenic effects of fluorouracil, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • flurbiprofen

              argatroban and flurbiprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • forskolin

              argatroban and forskolin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • fosphenytoin

              argatroban increases levels of fosphenytoin by unknown mechanism. Use Caution/Monitor.

              fosphenytoin, argatroban. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • garlic

              argatroban and garlic both increase anticoagulation. Modify Therapy/Monitor Closely.

            • gemcitabine

              gemcitabine increases effects of argatroban by unspecified interaction mechanism. Use Caution/Monitor. Due to the thrombocytopenic effects of gemcitabine, an additive risk of bleeding may be seen in patients receiving concomitant anticoagulants.

            • ginger

              argatroban and ginger both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ginkgo biloba

              argatroban and ginkgo biloba both increase anticoagulation. Modify Therapy/Monitor Closely.

            • glucagon intranasal

              glucagon intranasal increases effects of argatroban by unknown mechanism. Use Caution/Monitor.

            • green tea

              green tea, argatroban. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding, caution is advised.

            • hemin

              argatroban, hemin. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Hemin degradation product (ie, hematin) may produce coagulopathy (eg, thrombocytopenia, platelet degranulation) and cause mild anticoagulant effects.

            • horse chestnut seed

              argatroban and horse chestnut seed both increase anticoagulation. Modify Therapy/Monitor Closely.

            • hydrocortisone

              hydrocortisone, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • ibrutinib

              ibrutinib will increase the level or effect of argatroban by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

            • ibuprofen

              argatroban and ibuprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ibuprofen IV

              argatroban and ibuprofen IV both increase anticoagulation. Modify Therapy/Monitor Closely.

            • icosapent

              icosapent, argatroban. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.

            • imatinib

              imatinib, argatroban. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents; patients requiring anticoagulation while on imatinib should receive LMWH or unfractionated heparin instead of warfarin because of multiple interaction mechanisms of imatinib with warfarin.

            • indomethacin

              argatroban and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • iodine (radioactive)

              iodine (radioactive) decreases effects of argatroban by pharmacodynamic antagonism. Use Caution/Monitor.

            • ketoprofen

              argatroban and ketoprofen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ketorolac

              argatroban and ketorolac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ketorolac intranasal

              argatroban and ketorolac intranasal both increase anticoagulation. Modify Therapy/Monitor Closely.

            • lofepramine

              lofepramine increases levels of argatroban by decreasing metabolism. Use Caution/Monitor.

            • lornoxicam

              argatroban and lornoxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • meclofenamate

              argatroban and meclofenamate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • mefenamic acid

              argatroban and mefenamic acid both increase anticoagulation. Modify Therapy/Monitor Closely.

            • melatonin

              melatonin increases effects of argatroban by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

            • meloxicam

              argatroban and meloxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • methimazole

              methimazole decreases effects of argatroban by pharmacodynamic antagonism. Use Caution/Monitor.

            • methylprednisolone

              methylprednisolone, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • mistletoe

              argatroban increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • nabumetone

              argatroban and nabumetone both increase anticoagulation. Modify Therapy/Monitor Closely.

            • naproxen

              argatroban and naproxen both increase anticoagulation. Modify Therapy/Monitor Closely.

            • nettle

              argatroban increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • nintedanib

              nintedanib increases effects of argatroban by anticoagulation. Use Caution/Monitor. Nintedanib is a VEGFR inhibitor, and may increase the risk of bleeding; monitor patients on full anticoagulation therapy; monitor closely for bleeding and adjust therapy as needed .

            • omega 3 carboxylic acids

              omega 3 carboxylic acids, argatroban. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • omega 3 fatty acids

              omega 3 fatty acids, argatroban. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • oxaprozin

              argatroban and oxaprozin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • panax ginseng

              argatroban and panax ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • parecoxib

              argatroban and parecoxib both increase anticoagulation. Modify Therapy/Monitor Closely.

            • pau d'arco

              argatroban and pau d'arco both increase anticoagulation. Modify Therapy/Monitor Closely.

            • pegaspargase

              pegaspargase increases effects of argatroban by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.

            • phenytoin

              argatroban increases levels of phenytoin by unknown mechanism. Use Caution/Monitor.

              phenytoin, argatroban. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • phytoestrogens

              argatroban and phytoestrogens both increase anticoagulation. Modify Therapy/Monitor Closely.

            • piroxicam

              argatroban and piroxicam both increase anticoagulation. Modify Therapy/Monitor Closely.

            • porfimer

              argatroban decreases effects of porfimer by pharmacodynamic antagonism. Use Caution/Monitor.

            • prasugrel

              argatroban, prasugrel. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced risk of hemorrhage.

            • prednisolone

              prednisolone, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • prednisone

              prednisone, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • propafenone

              propafenone increases effects of argatroban by decreasing metabolism. Use Caution/Monitor.

            • propylthiouracil

              propylthiouracil decreases effects of argatroban by pharmacodynamic antagonism. Use Caution/Monitor.

            • reishi

              argatroban and reishi both increase anticoagulation. Modify Therapy/Monitor Closely.

            • reteplase

              argatroban and reteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • rifabutin

              rifabutin decreases levels of argatroban by increasing metabolism. Use Caution/Monitor.

            • rivaroxaban

              rivaroxaban, argatroban. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

            • salicylates (non-asa)

              argatroban and salicylates (non-asa) both increase anticoagulation. Modify Therapy/Monitor Closely.

            • salsalate

              argatroban and salsalate both increase anticoagulation. Modify Therapy/Monitor Closely.

            • saw palmetto

              saw palmetto increases toxicity of argatroban by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.

            • Siberian ginseng

              argatroban and Siberian ginseng both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulfasalazine

              argatroban and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.

            • sulindac

              argatroban and sulindac both increase anticoagulation. Modify Therapy/Monitor Closely.

            • tenecteplase

              argatroban and tenecteplase both increase anticoagulation. Modify Therapy/Monitor Closely.

            • ticagrelor

              ticagrelor, argatroban. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.

            • tipranavir

              tipranavir increases effects of argatroban by pharmacodynamic synergism. Use Caution/Monitor. Tipranavir has mild antiplatelet activity that may incr bleeding risk.

            • tolfenamic acid

              argatroban and tolfenamic acid both increase anticoagulation. Modify Therapy/Monitor Closely.

            • tolmetin

              argatroban and tolmetin both increase anticoagulation. Modify Therapy/Monitor Closely.

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension, argatroban. Other (see comment). Use Caution/Monitor. Comment: Corticosteroids may decrease anticoagulant effects by increasing blood coagulability; conversely, they may impair vascular integrity, thus increasing bleeding risk. Monitor INR closely.

            • triclofos

              triclofos increases effects of argatroban by unspecified interaction mechanism. Use Caution/Monitor.

            • vorapaxar

              argatroban, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • vortioxetine

              vortioxetine and argatroban both increase anticoagulation. Use Caution/Monitor.

            • zanubrutinib

              argatroban, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

            Minor (17)

            • acetaminophen

              acetaminophen increases effects of argatroban by unknown mechanism. Minor/Significance Unknown.

            • acetaminophen IV

              acetaminophen IV increases effects of argatroban by unknown mechanism. Minor/Significance Unknown.

            • acetaminophen rectal

              acetaminophen rectal increases effects of argatroban by unknown mechanism. Minor/Significance Unknown.

            • alprostadil intracavernous/urethral

              alprostadil intracavernous/urethral increases effects of argatroban by pharmacodynamic synergism. Minor/Significance Unknown.

            • ceftaroline

              ceftaroline increases effects of argatroban by Other (see comment). Minor/Significance Unknown. Comment: Cephalosporins with a methylthiotetrazole (MTT) side ring (eg, cefotetan, cefoperazone) are more frequently associated with hypoprothrombinemic activity.

            • chlorella

              chlorella decreases effects of argatroban by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical, due to vitamin K content.

            • demeclocycline

              demeclocycline increases effects of argatroban by pharmacodynamic synergism. Minor/Significance Unknown.

            • dexmethylphenidate

              dexmethylphenidate increases effects of argatroban by decreasing metabolism. Minor/Significance Unknown.

            • doxycycline

              doxycycline increases effects of argatroban by pharmacodynamic synergism. Minor/Significance Unknown.

            • glyburide

              glyburide increases effects of argatroban by unspecified interaction mechanism. Minor/Significance Unknown.

            • mineral oil

              mineral oil decreases levels of argatroban by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • minocycline

              minocycline increases effects of argatroban by pharmacodynamic synergism. Minor/Significance Unknown.

            • oxytetracycline

              oxytetracycline increases effects of argatroban by pharmacodynamic synergism. Minor/Significance Unknown.

            • quinidine

              quinidine increases effects of argatroban by decreasing metabolism. Minor/Significance Unknown.

            • tetracycline

              tetracycline increases effects of argatroban by pharmacodynamic synergism. Minor/Significance Unknown.

            • verteporfin

              argatroban decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • vitamin E

              vitamin E, argatroban. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Vitamin E at RDA does not change INR in pts. on chronic warfarin therapy; megadoses (~10x RDA) may enhance anticoagulant effects in vitamin K deficient pts.

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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

            Use caution in hepatic impairment; achievement of steady-state aPTT levels may take longer and require more argatroban dose adjustments in patients with hepatic impairment compared to patients with normal hepatic function; avoid use of high doses in patients undergoing percutaneous coronary intervention (PCI) who have clinically significant hepatic disease

            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

            Risk of hemorrhage

            • Hemorrhage can occur at any site in the body
            • Intracranial and retroperitoneal hemorrhage reported
            • Unexplained fall in hematocrit or blood pressure after lumbar puncture, spinal anesthesia, major surgery (especially involving the brain, spinal cord, or eye) associated with hemorrhage;
            • Hematologic conditions may increase risk of hemorrhage, such as congenital or acquired bleeding disorders, and gastrointestinal lesions such as ulcerations
            • Concomitant use of argatroban with antiplatelet agents, thrombolytics, and other anticoagulants may increase risk of bleeding
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            Pregnancy & Lactation

            Pregnancy

            Limited data from published literature and postmarketing reports do not suggest an association between argatroban and adverse fetal developmental outcomes; there are risks to mother associated with untreated thrombosis in pregnancy and a risk of hemorrhage in mother and fetus associated with use of anticoagulants

            Pregnancy confers an increased risk for thromboembolism that is higher for women with underlying thromboembolic disease and certain high risk pregnancy conditions; published data describe that women with a previous history of venous thrombosis are at high risk for recurrence during pregnancy

            Use of anticoagulants, including argatroban, may increase risk of bleeding in fetus and neonate; monitor neonates for bleeding

            Pregnant women should be carefully monitored for evidence of excessive bleeding or unexpected changes in coagulation parameters during labor or delivery

            Animal data

            • In animal reproduction studies, there was no evidence of adverse developmental outcomes with intravenous administration of argatroban during organogenesis in rats and rabbits at doses up to 0.3- and 0.2-times, respectively, the maximum recommended human dose (MHRD)

            Lactation

            There are no data on presence in human milk, or effects on milk production; it is present in rat milk; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition

            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

            BRAND FORM. UNIT PRICE PILL IMAGE
            argatroban intravenous
            -
            100 mg/mL vial
            argatroban intravenous
            -
            100 mg/mL vial
            argatroban intravenous
            -
            100 mg/mL vial
            argatroban intravenous
            -
            100 mg/mL vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            argatroban intravenous

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.