eptifibatide (Rx)

Brand and Other Names:Integrilin
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injection solution

  • 2mg/mL
  • 0.75mg/mL

Acute Coronary Syndromes

180 mcg/kg IV bolus over 1-2 min, THEN  

2 mcg/kg/min IV continuous infusion; continue infusion until hospital discharge or initiation of coronary artery bypass graft surgery (CABG), up to 72 hours

Patient to undergo PCI: infusion should be continued until hospital discharge or for up to 18- 24 hr after procedure, whichever comes first, allowing for up to 96 hr of therapy

Administer aspirin (160-325 mg) daily

Dosing considerations

  • Administer concomitantly with heparin dosed to achieve the following parameters:
    • During medical management
      • Target aPTT 50 - 70 seconds
      • If weight greater than or equal to 70 kg, 5000-unit bolus followed by infusion of 1000 units/h
      • If weight less than 70 kg, 60-units/kg bolus followed by infusion of 12 units/kg/h
    • During PCI
      • Target ACT 200 to 300 seconds
      • If heparin is initiated prior to PCI, additional boluses during PCI to maintain an ACT target of
      • 200 to 300 seconds.
      • Heparin infusion after the PCI is discouraged

Percutaneous Coronary Intervention

180 mcg/kg IV bolus immediately, THEN  

Continuous infusion 2 mcg/kg/min with another 180 mcg/kg IV bolus 10 minutes after 1st bolus

Continue infusion until hospital discharge, or for up to 18 to 24 hours, whichever comes first; minimum 12 hr infusion recommended

In patients who undergo CABG surgery, drug infusion should be discontinued prior to surgery

Administer aspirin, 160 to 325 mg, 1 to 24 hours prior to PCI and daily thereafter

  • Dosing considerations

    • Administer concomitantly with heparin to achieve a target ACT of 200 to 300 seconds
    • Administer 60-units/kg bolus initially in patients not treated with heparin within 6 hours prior to PCI.
    • Additional boluses during PCI to maintain ACT within target.
    • Heparin infusion after the PCI is strongly discouraged

Discontinue administration in patients requiring thrombolytic therapy

Renal Impairment

(CrCl <50 mL/min)

ACS: 180 mcg/kg IV bolus as soon as possible, THEN continuous infusion 1 mcg/kg/min  

PCI: 180 mcg/kg IV immediately before PCI, THEN continuous infusion 1 mcg/kg/min with another 180 mcg/kg IV bolus 10 minutes after 1st bolus

Hemodialysis: Safety and using during hemodialysis not established

Safety & efficacy not established

In clinical trials, incidence of bleeding complications was higher in the elderly in both placebo and eptifibatide groups, and the incremental risk of eptifibatide-associated bleeding was greater in the older patients. Adjust dose to renal function

Acute Coronary Syndromes

180 mcg/kg IV bolus over 1-2 min, THEN  

2 mcg/kg/min IV for up to 72 hr

Percutaneous Coronary Intervention

180 mcg/kg IV, THEN

Continuous infusion 2 mcg/kg/min with another 180 mcg/kg IV bolus 10 minutes after 1st one

Continue infusion for at least 12 hours

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Interactions

Interaction Checker

and eptifibatide

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (12)

              • antithrombin alfa

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

              • antithrombin III

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

              • apixaban

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

              • argatroban

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

              • aspirin rectal

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

              • bivalirudin

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

              • dalteparin

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

              • enoxaparin

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

              • fondaparinux

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

              • heparin

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

              • protamine

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

              • warfarin

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

              Monitor Closely (21)

              • acalabrutinib

                acalabrutinib increases effects of eptifibatide 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, eptifibatide. 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, eptifibatide. 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, eptifibatide. 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

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

              • caplacizumab

                caplacizumab, eptifibatide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • citalopram

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

              • dabigatran

                dabigatran, eptifibatide. 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, eptifibatide. 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.

              • edoxaban

                edoxaban, eptifibatide. 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 eptifibatide 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 eptifibatide by pharmacodynamic synergism. Use Caution/Monitor. (Theoretical interaction). Combination may increase risk of bleeding.

              • ibrutinib

                ibrutinib will increase the level or effect of eptifibatide 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, eptifibatide. 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 eptifibatide by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

              • piracetam

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

              • porfimer

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

              • rivaroxaban

                rivaroxaban, eptifibatide. 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

                eptifibatide 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, eptifibatide. 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

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

              Minor (6)

              • devil's claw

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

              • ginger

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

              • ginkgo biloba

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

              • horse chestnut seed

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

              • levothyroxine

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

              • verteporfin

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

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              Adverse Effects

              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)

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              Warnings

              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 bleeding is the most common complication; minimize use of arterial and venous punctures, intramuscular injections, and use of urinary catheters, nasotracheal intubation, and nasogastric tubes; when obtaining intravenous access, avoid non-compressible sites (eg, subclavian or jugular veins)
              • Risk factors for bleeding include older age, a history of bleeding disorders, and concomitant use of drugs that increase risk of bleeding (thrombolytics, oral anticoagulants, nonsteroidal anti-inflammatory drugs, and P2Y12 inhibitors); concomitant treatment with other inhibitors of platelet receptor glycoprotein (GP) IIb/IIIa should be avoided; in patients treated with heparin, bleeding can be minimized by close monitoring of aPTT and ACT
              • In patients undergoing PCI, treatment may increase in major and minor bleeding at site of arterial sheath placement; after PCI, infusion should be continued until hospital discharge or up to 18 - 24 hours, whichever comes first;
              • Heparin use is discouraged after PCI procedure; early sheath removal is encouraged while drug is being infused; prior to removing the sheath, it is recommended that heparin be discontinued for 3 to 4 hours and an aPTT of <45 seconds or ACT <150 seconds be achieved; in any case, both drugs should be discontinued and sheath hemostasis achieved at least 2 to 4 hours before hospital discharge; if bleeding at access site cannot be controlled with pressure, infusion of both drugs should be discontinued immediately

              Thrombocytopenia

              • There have been reports of acute, profound thrombocytopenia (immune-mediated and non-immune mediated); in the event of acute profound thrombocytopenia or a confirmed platelet decrease to <100,000/mm3, discontinue drug and heparin (unfractionated or low-molecular weight); monitor serial platelet counts, assess presence of drug-dependent antibodies, and treat as appropriate
              • There has been no clinical experience with therapy initiated in patients with a baseline platelet count <100,000/mm3; if a patient with low platelet counts is receiving drug, their platelet count should be monitored closely
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              Pregnancy & Lactation

              Pregnancy

              Available data on use in pregnant women from published literature and pharmacovigilance database are insufficient to establish a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

              Untreated myocardial infarction can be fatal to pregnant woman and fetus

              Myocardial infarction is a medical emergency in pregnancy which can be fatal to a pregnant woman and fetus if left untreated; therapy for pregnant woman should not be withheld because of potential concerns regarding effects of drug on the fetus

              Animal data

              • In animal reproduction studies, there was no evidence of adverse developmental effects when administered intravenously to pregnant rats and rabbits at approximately 4 times recommended maximum daily human dose
              • Estimated background risk of major birth defects and miscarriage for indicated population is unknown; all pregnancies have a background risk of birth defect, loss, or other adverse outcomes

              Lactation

              There are no available data on presence of drug in human milk, effects on breastfed infant, or on milk production; as drug is a peptide, it is likely to be destroyed in infant’s gastrointestinal tract and not absorbed orally by the breastfed infant

              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

              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

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              Administration

              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

              Inspect for particulate matter and discoloration prior to administration, whenever solution and container permit

              May administer in the same intravenous line as alteplase, atropine, dobutamine, heparin, lidocaine, meperidine, metoprolol, midazolam, morphine, nitroglycerin, or verapamil

              Do not administer through the same intravenous line as furosemide

              May administer in the same IV line with 0.9% NaCl or 0.9% NaCl/5% dextrose; with either vehicle, the infusion may also contain up to 60 mEq/L of potassium chloride

              Withdraw bolus dose(s) from the 10-mL vial into a syringe; administer bolus dose(s) by IV push

              Immediately following bolus dose administration, initiate a continuous infusion

              When using an intravenous infusion pump, administer undiluted directly from 100-mL vial

              Spike the 100-mL vial with a vented infusion set; center the spike within the circle on the stopper top

              Discard any unused portion left in the vial

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              eptifibatide intravenous
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              0.75 mg/mL vial
              eptifibatide intravenous
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              2 mg/mL vial
              eptifibatide intravenous
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              2 mg/mL vial
              eptifibatide intravenous
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              2 mg/mL vial
              eptifibatide intravenous
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              2 mg/mL vial
              eptifibatide intravenous
              -
              2 mg/mL vial
              eptifibatide intravenous
              -
              2 mg/mL vial
              eptifibatide intravenous
              -
              0.75 mg/mL vial
              eptifibatide intravenous
              -
              0.75 mg/mL vial
              eptifibatide intravenous
              -
              2 mg/mL vial
              eptifibatide intravenous
              -
              0.75 mg/mL vial
              eptifibatide intravenous
              -
              0.75 mg/mL solution

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              eptifibatide 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

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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.
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              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
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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.