abciximab (Rx)

Brand and Other Names:ReoPro
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 2mg/mL

Adjunct to PCI

Prevention of cardiac ischemic complications in patients undergoing PCI

0.25 mg/kg IV bolus over at least 1 min, 10-60 min before start of PCI, THEN

0.125 mcg/kg/min IV continuous infusion for 12 hr; not to exceed infusion rate of 10 mcg/min  

Unstable Angina

Indicated for prevention of cardiac complications in patients with unstable angina with PCI planned within 24 hr

0.25 mg/kg IV bolus over at least 1 minute, THEN

0.125 mcg/kg/min IV continiuous infusion for 18-24 hr concluding 1 hour post-PCI; not to exceed 10 mcg/min  

Stop continuous infusion of abciximab in patients with failed PCIs

Other Indications & Uses

Adjunctive therapy during thrombolysis (off-label)

Safety and efficacy not established

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Interactions

Interaction Checker

and abciximab

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
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            Contraindicated (0)

              Serious - Use Alternative (14)

              • antithrombin alfa

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

              • antithrombin III

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

              • apixaban

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

              • argatroban

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

              • aspirin rectal

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

              • bemiparin

                bemiparin, abciximab. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

              • bivalirudin

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

              • dalteparin

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

              • enoxaparin

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

              • fondaparinux

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

              • heparin

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

              • phenindione

                phenindione, abciximab. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

              • protamine

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

              • warfarin

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

              Monitor Closely (20)

              • acalabrutinib

                acalabrutinib increases effects of abciximab 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, abciximab. 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/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate, abciximab. 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/citric acid/sodium bicarbonate, abciximab. 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, abciximab. 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

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

              • caplacizumab

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

              • citalopram

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

              • dabigatran

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

              • ibrutinib

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

              • porfimer

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

              • rivaroxaban

                rivaroxaban, abciximab. 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

                abciximab 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, abciximab. 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

                abciximab, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

              Minor (5)

              • devil's claw

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

              • ginger

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

              • ginkgo biloba

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

              • horse chestnut seed

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

              • verteporfin

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

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              Adverse Effects

              >10%

              Bleeding, minor (70-82%)

              Bleeding, major (17-21%)

              Hypotension (14-21%)

              Back pain (17.6%)

              Nausea (13.6%)

              Chest pain (11.4%)

              Vomiting (7-11%)

              1-10%

              Headache (6%)

              Thrombocytopenia (2-6%)

              Bradycardia (5%)

              Injection site pain (3.6%)

              Extremity pain (3.5%)

              Abdominal pain (3%)

              UTI (2%)

              Dizziness (1.8%)

              Peripheral edema (1.6%)

              Anemia (1.2%)

              Diarrhea (1%)

              Hypoesthesia (1%)

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              Warnings

              Contraindications

              Hypersensitivity

              Active internal bleeding

              Recent (within six weeks) gastrointestinal (GI) or genitourinary (GU) bleeding of clinical significance

              History of CVA (within 2 years) or CVA with a significant residual neurological deficit

              Bleeding diathesis

              Administration of oral anticoagulants within seven days unless prothrombin time is ≤1.2 times control

              Thrombocytopenia (< 100,000 cells/μL)

              Recent (within six weeks) major surgery or trauma

              Intracranial neoplasm, arteriovenous malformation, or aneurysm

              Severe uncontrolled hypertension

              Presumed or documented history of vasculitis

              Cautions

              Intended for use with aspirin and heparin, and has only been studied in that setting

              Allergic reactions, some of which were anaphylaxis (sometimes fatal), reported rarely in patients receiving therapy; patients with allergic reactions should receive appropriate treatment; treatment of anaphylaxis should include immediate discontinuation of therapy and initiation of resuscitative measures

              In the event of serious uncontrolled bleeding or need for emergency surgery, therapy should be discontinued; if platelet function does not return to normal, it may be restored, at least in part, with platelet transfusions

              Bleeding events

              • Has the potential to increase risk of bleeding events, rarely including those with a fatal outcome, particularly in presence of anticoagulation, eg, from heparin, other anticoagulants, or thrombolytics
              • Risk of major bleeds due to therapy is increased in patients receiving thrombolytics and should be weighed against anticipated benefits
              • Should serious bleeding occur that is not controllable with pressure, the infusion of this medication and any concomitant heparin should be stopped

              Bleeding precautions

              • To minimize risk of bleeding, important to use a low-dose, weight-adjusted heparin regimen, a weight-adjusted Abciximab bolus and infusion, strict anticoagulation guidelines, careful vascular access site management, discontinuation of heparin after procedure and early femoral arterial sheath removal
              • Therapy requires careful attention to all potential bleeding sites including catheter insertion sites, arterial and venous puncture sites, cutdown sites, needle puncture sites, and gastrointestinal, genitourinary, pulmonary (alveolar), and retroperitoneal sites
              • Arterial and venous punctures, intramuscular injections, and use of urinary catheters, nasotracheal intubation, nasogastric tubes and automatic blood pressure cuffs should be minimized
              • When obtaining intravenous access, non-compressible sites (eg, subclavian or jugular veins) should be avoided; saline or heparin locks should be considered for blood drawing; vascular puncture sites should be documented and monitored; gentle care should be provided when removing dressings
              • Arterial access site care is important to prevent bleeding; care should be taken when attempting vascular access that only anterior wall of femoral artery is punctured, avoiding a Seldinger (through and through) technique for obtaining sheath access
              • Femoral vein sheath placement should be avoided unless needed; while vascular sheath is in place, patients should be maintained on complete bed rest with head of the bed ≤30°and affected limb restrained in a straight position; patients may be medicated for back/groin pain as necessary
              • Discontinuation of heparin immediately upon completion of procedure and removal of arterial sheath within six hours is strongly recommended if APTT ≤50 sec or ACT ≤175 sec; in all circumstances, heparin should be discontinued at least two hours prior to arterial sheath removal
              • Following sheath removal, pressure should be applied to femoral artery for at least 30 minutes using either manual compression or a mechanical device for hemostasis; a pressure dressing should be applied following hemostasis; the patient should be maintained on bed rest for six to eight hours following sheath removal or discontinuation of therapy, or four hours following discontinuation of heparin, whichever is later
              • The pressure dressing should be removed prior to ambulation; the sheath insertion site and distal pulses of affected leg(s) should be frequently checked while the femoral artery sheath is in place and for six hours after femoral artery sheath removal; any hematoma should be measured and monitored for enlargement
              • The following conditions have been associated with an increased risk of bleeding and may be additive with effect of therapy in the angioplasty setting: PCI within 12 hr of onset of symptoms for acute myocardial infarction, prolonged PCI (lasting more than 70 minutes) and failed PCI

              Use of thrombolytics, anticoagulants, and other antiplatelet agents

              • Because drug inhibits platelet aggregation, caution should be employed when it is used with other drugs that affect hemostasis, including thrombolytics, oral anticoagulants, non-steroidal anti-inflammatory drugs, dipyridamole, and ticlopidine
              • Because of observed synergistic effects on bleeding, therapy should be used judiciously in patients who have received systemic thrombolytic therapy

              Thrombocytopenia

              • Thrombocytopenia, including severe thrombocytopenia, reported with therapy
              • Monitor platelet counts prior to, during, and after treatment
              • Acute decreases in platelet count should be differentiated between true thrombocytopenia and pseudothrombocytopenia
              • If true thrombocytopenia is verified, therapy should be immediately discontinued, and the condition appropriately monitored and treated
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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: not known if excreted in breast milk; use 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.

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              Pharmacology

              Mechanism of Action

              Chimeric monoclonal antibody; prevents binding of fibrinogen, vWF to glycoprotein IIb/IIIa receptor sites on platelets

              Pharmacokinetics

              Half-life: 30 min

              Onset: 10 min (<20% of baseline)

              Duration: 72 hr

              Metabolism: Through proteolytic cleavage

              Platelet binding: Remains bound for 15 days

              Peak time: ~30 min (platelet inhibition)

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              Administration

              IV Compatibilities

              Solution: D5W, NS

              Y-site: adenosine, atropine, bivalirudin, diphenhydramine, fentanyl, metoprolol, midazolam

              IV Preparation

              Do not add any other drugs in same IV line

              Bolus injection: withdraw through 0.22 micron filter

              Infusion: withdraw 4.5 mL (9 mg) through filter into syringe; inject into 250 mL of NS or D5W; final concentration 35 mcg/mL

              Do not shake vial

              IV Administration

              Bolus over at least 1 min

              See adult dosing for infusion rate

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              Formulary

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              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
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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.