Adult Dosing
Acute coronary syndrome
- Start: 180 mcg/kg IV bolus; then begin continuous infusion of 2 mcg/kg/min until discharge or initiation of CABG surgery up to 72 hrs
Note: For patient's undergoing a percutaneous coronary intervention (PCI) while receiving eptifibatide continue infusion up to hospital discharge, or for up to 18-24 hrs after the procedure, whichever comes first, allowing for up to 96 hrs of therapy
Percutaneous coronary intervention (PCI)
- Start: 180 mcg/kg IV bolus before the initiation of PCI; then begin continuous infusion of 2 mcg/kg/min and a second 180-mcg/kg IV bolus 10 minutes after the first load
Note: Continue infusion until hospital discharge, or for up to 18-24 hrs whichever comes first. Maintain a minimum of 12 hrs of infusion
Acute Coronary Syndromes [Non-FDA Approved]
- 180 mcg/kg IV bolus followed in 10 mins by further 180 mcg/kg bolus
- Infusion dose starts after 1st IV bolus at 2.0 mcg/kg/min (reduce by 50% if eGFR < 50 ml/min)
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Acute coronary syndrome
- <50 mL/min: Start 180 mcg/kg IV bolus immediately following diagnosis, then begin a continuous infusion of 1 mcg/kg/min
- Percutaneous coronary intervention (PCI)
- <50 mL/min: Start 180 mcg/kg IV bolus immediately before the initiation of the procedure, then begin a continuous infusion of 1 µg/kg/min and a second 180-µg/kg bolus administered 10 minutes after the first
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Bleeding is associated with therapy of this drug. Major bleeding occurs from the arterial access site for cardiac catheterization or from the GI or GU tract
- Take utmost care to minimize the risk of bleeding in patients undergoing percutaneous coronary interventions
- Immediately stop infusion of eptifibatide and concomitant heparin if bleeding is not controlled with pressure
- Take utmost care of the femoral artery access site in patients undergoing percutaneous coronary intervention (PCI). Continue eptifibatide infusion until hospital discharge or up to 18-24 hrs. Discourage heparin use after the PCI procedure. Discontinue heparin for 3-4 hrs and achieve an aPTT of <45 seconds or ACT <150 seconds prior to removal of sheath. Discontinue heparin and eptifibatide and achieve sheath hemostasis at least 2-4 hrs before hospital discharge
- Avoid concomitant treatment with other inhibitors of platelet receptor GP IIb/IIIa for avoiding potential additive pharmacologic effects
- Eptifibatide is associated with an increase in the incidence of bleeding and transfusions compared to the incidence seen when streptokinase given alone.
- Use systemic thrombolytic therapy with caution in patients receiving eptifibatide
- Minimize arterial and venous punctures, IM injections, and the use of urinary catheters, nasotracheal intubation, and nasogastric tubes should bed
- Avoid noncompressible sites while obtaining intravenous access
- Perform hematocrit or hemoglobin, platelet count, serum creatinine, and PT/aPTT before infusion of eptifibatide for identifying preexisting hemostatic abnormalities. Measure the activated clotting time (ACT) in patients undergoing PCI
- Maintain aPTT between 50-70 secs unless PCI is to be performed. Closely monitor aPTT for minimizing risk of bleeding in patients treated with heparin
- Discontinue therapy with this drug and heparin on development of platelet count <100,000/mm3. Monitor and treat such condition as appropriately
Cautions: Use cautiously in
- Renal impairment
- Concomitant use with drugs affecting hemostasis
Pregnancy Category:B
Breastfeeding: Unknown whether eptifibatide is excreted in milk. Manufacturer recommends caution when eptifibatide is administered to a nursing mother.
