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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             activity indicator 

            Contraindicated (1)

            • abrocitinib

              abrocitinib and tirofiban both increase anticoagulation. Contraindicated. Antiplatelet drugs, except for low-dose aspirin (=81 mg qDay), during the first 3 months of treatment are contraindicated.

            Serious - Use Alternative (12)

            • antithrombin alfa

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

            • antithrombin III

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

            • apixaban

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

            • argatroban

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

            • aspirin rectal

              aspirin rectal increases effects of tirofiban by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

            • bivalirudin

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

            • caplacizumab

              caplacizumab, tirofiban. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug.

            • dalteparin

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

            • enoxaparin

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

            • fondaparinux

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

            • heparin

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

            • protamine

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

            Monitor Closely (22)

            • acalabrutinib

              acalabrutinib increases effects of tirofiban by anticoagulation. Modify Therapy/Monitor Closely. 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.

            • aspirin

              aspirin, tirofiban. Either increases toxicity of the other by pharmacodynamic synergism. 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/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, tirofiban. Either increases toxicity of the other by pharmacodynamic synergism. 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.

            • azficel-T

              azficel-T, tirofiban. 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

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

            • citalopram

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

            • dabigatran

              dabigatran, tirofiban. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

            • deferasirox

              deferasirox, tirofiban. 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.

            • defibrotide

              defibrotide increases effects of tirofiban by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.

            • edoxaban

              edoxaban, tirofiban. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding. The need for simultaneous use of platelet aggregation inhibitors with anticoagulants is common for patients with cardiovascular disease, but may result in increased bleeding; monitor closely. Promptly evaluate any signs or symptoms of blood loss.

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of tirofiban 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.

            • green tea

              green tea increases effects of tirofiban by pharmacodynamic synergism. Use Caution/Monitor. (Theoretical interaction). Combination may increase risk of bleeding.

            • ibrutinib

              ibrutinib will increase the level or effect of tirofiban 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.

            • icosapent

              icosapent, tirofiban. 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.

            • melatonin

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

            • piracetam

              piracetam increases effects of tirofiban by pharmacodynamic synergism. Use Caution/Monitor.

            • porfimer

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

            • rivaroxaban

              rivaroxaban, tirofiban. 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.

            • selumetinib

              tirofiban and selumetinib both increase anticoagulation. Modify Therapy/Monitor Closely. An increased risk of bleeding may occur in patients taking a vitamin-K antagonist or an antiplatelet agent with selumetinib. Monitor for bleeding and INR or PT in patients coadministered a vitamin-K antagonist or an antiplatelet agent with selumetinib.

            • ticagrelor

              ticagrelor, tirofiban. 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.

            • vortioxetine

              tirofiban increases effects of vortioxetine by anticoagulation. Use Caution/Monitor.

            • warfarin

              tirofiban, warfarin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Drugs with antiplatelet properties may increase anticoagulation effect of warfarin.

            Minor (6)

            • devil's claw

              devil's claw, tirofiban. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

            • ginger

              ginger, tirofiban. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

            • ginkgo biloba

              ginkgo biloba, tirofiban. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

            • horse chestnut seed

              horse chestnut seed, tirofiban. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Theoretical. Use with caution.

            • levothyroxine

              levothyroxine decreases levels of tirofiban by increasing renal clearance. Minor/Significance Unknown.

            • verteporfin

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

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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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            Images

            No images available for this drug.
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            Patient Handout

            Patient Education
            tirofiban 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) 2022 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

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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.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the 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.