eptifibatide (Rx)

1-10%

Bleeding (8%)

Hypotension (7%)

Thrombocytopenia (2.3%)

Injection site reaction

<1%

Hypersensitivity

Intracranial hemorrhage

Pulmonary hemorrhage

Thrombocytopenia

GI hemorrhage

Postmarketing Reports

Immune-mediated thrombocytopenia (thought to be caused by antibodies that react with GP IIb/IIIa complex)

Contraindications

Hypersensitivity

History of internal bleeding, intracranial hemorrhage or neoplasm, CVA, thrombocytopenia

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

Other parenteral glycoprotein IIb/IIIa inhibitors

Cautions

Bleeding at the site of arterial sheath placement is the most common complication

Early sheath removal is encouraged while eptifibatide is being infused; prior to removing the sheath, it is recommended that heparin be discontinued for 3-4 hr and an aPTT of <45 seconds or ACT <150 seconds be achieved

Thrombocytopenia: Discontinue if platelet levels <100,000 mm/cu.mm

Pregnancy Category: B

Lactation: excretion in milk unknown; use with caution

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.

Mechanism of Action

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

Pharmacokinetics

Half-life, elimination: 2.5 hr

Onset: 1 hr

Duration: 4 hr

Protein bound: 25%

Vd: 185-260 mL/kg

Metabolites: Deaminated eptifibatide, other more polar metabolites detected in urine, no metabolites detected in plasma

Clearance: 55-58 mL/kg/hr

Excretion: Urine

IV Incompatibilities

Y-site, additive, syringe: furosemide

IV Compatibilities

Y-site: alteplase, amiodarone, atropine, bivalirudin, dobutamine, heparin, lidocaine, meperidine, metoprolol, midazolam, morphine sulfate, nitroglycerin, verapamil

IV Preparation

Bolus injection: withdraw from 10 mL vial (2 mg/mL; 10, 100 mL)

Infusion: no prep needed; spike 100 ml vial with vented infusion set (0.75 mg/mL; 100 mL)

IV Administration

Bolus: administer undiluted over 1-2 min