abciximab (Rx)

>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%)

Contraindications

Hypersensitivity

Active major bleeding, thrombocytopenia, history of CVA (within 2 years)

Peptic ulcer disease

Recent surgery of trauma, intracranial neoplasm, uncontrolled HTN, vasculitis

Oral anticoagulant use within 7 days increases bleeding risk

Cautions

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

Increased bleeding risk when used with thrombolytic agents

Thrombocytopenia

• 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

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.

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)

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