Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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 (63)
- 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.
- caplacizumab
caplacizumab, argatroban. Either increases effects of the other by anticoagulation. 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 increases effects of warfarin by anticoagulation. Avoid or Use Alternate Drug. Avoid combined use once INR is established in the desired therapeutic range.
Monitor Closely (121)
- 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.
- 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 (18)
- 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.
- serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate 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.
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
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
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.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%)
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
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.
Patient Handout
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) 2023 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.
Formulary
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