tirofiban (Rx)

Brand and Other Names:Aggrastat
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

premixed IV infusion solution

  • 5mg/100mL (50mcg/mL)
  • 12.5mg/250mL (50mcg/mL)

IV solution vials

  • 5mg/100mL vial (50mcg/mL)
  • 3.75mg/15mL bolus vial (250mcg/mL)

Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS)

Indicated to reduce rate of thrombotic cardiovascular events (combined endpoint of death, myocardial infarction, or refractory ischemia/repeat cardiac procedure) in NSTE-ACS

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

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

Refer to prescribing information for dosing chart by weight and CrCl

Renal Impairment

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

Safety and efficacy not established

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Interactions

Interaction Checker

and tirofiban

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Bleeding, minor (11%)

            1-10%

            Pelvic pain (6%)

            Coronary artery dissection (5%)

            Bradycardia (4%)

            Dizziness (3%)

            Lower extremity pain (3%)

            Edema (2%)

            Sweating (2%)

            Bleeding, major (1-2%)

            Thrombocytopenia (1.5%)

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            Warnings

            Contraindications

            Severe hypersensitivity reaction to drug (i.e., anaphylactic reactions) or excipients

            History of thrombocytopenia following prior exposure to therapy

            Active internal bleeding or history of bleeding diathesis, major surgical procedure or severe physical trauma within previous month

            Cautions

            Bleeding is most common complication encountered during therapy; most bleeding associated with therapy occurs at arterial access site for cardiac catheterization; minimize use of traumatic or potentially traumatic procedures such as arterial and venous punctures, intramuscular injections, nasotracheal intubation, etc.

            Concomitant use of fibrinolytics, anticoagulants and antiplatelet drugs increases risk of bleeding

            Profound thrombocytopenia reported; monitor platelet counts beginning about 6 hr after treatment initiation and daily thereafter; If platelet count decreases to < 90,000/mm3, monitor platelet counts to exclude pseudothrombocytopenia; if thrombocytopenia confirmed, discontinue therapy and heparin; previous exposure to a glycoprotein (GP) IIb/IIIa receptor antagonist may increase risk of developing thrombocytopenia

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            Pregnancy & Lactation

            Pregnancy

            While published data cannot definitively establish the absence of risk, available published case reports have not established an association with therapy during pregnancy and major birth defects, miscarriage, or adverse maternal or fetal outcomes

            Untreated myocardial infarction can be fatal to the pregnant woman and fetus; myocardial infarction is a medical emergency in pregnancy which can be fatal to pregnant woman and fetus if left untreated

            Animal data

            • Studies with intravenous doses up to 5 mg/kg/day (about 5 and 13 times maximum recommended daily human dose for rat and rabbit, respectively, compared on a body surface area basis) have revealed no harm to fetus

            Lactation

            There is no data on presence of drug in human milk, effects on breastfed infant, or on human milk production; however, the drug is present in rat milk; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed child 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

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

            Pharmacokinetics

            Half-life: 2 hr

            Duration: 4 hr

            Protein bound: 65%

            Vd: 22-42 L

            Clearance: 213-314 mL/min

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

            Dialyzable: Yes

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            Administration

            IV Incompatibilities

            Y-site: diazepam

            IV Compatibilities

            Solution: D5W, D5/½NS, NS

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

            IV Preparation

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

            IV Administration

            See adult dosing for infusion rate

            Storage

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

            Do not freeze

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

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            Formulary

            FormularyPatient Discounts

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

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

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