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

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             activity indicator 

            Contraindicated (1)

            • abrocitinib

              abrocitinib and abciximab 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 (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.

            • caplacizumab

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

            • 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.

            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.

            • 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.

            • warfarin

              abciximab, 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 (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

            FormularyPatient Discounts

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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.