Adult Dosing
Acute coronary syndrome
- Start 0.4 mcg/kg/minute for 30 minutes, then continue at 0.1 mcg/kg/minute through angiography and for 12-24 hrs after angioplasty/atherectomy
Notes:- Administer along with heparin and aspirin
- Tirofiban injection (250 mcg/mL) should be diluted to the same concentration as tirofiban injection premixed (50 mcg/mL) using 0.9% NaCl or 5% dextrose in water
- Avoid using plastic containers in series connections to prevent risk of air embolism
- Do not administer in the same IV line as diazepam
- Avoid adding other drugs or removing solution directly from the bag using a syringe
Acute Coronary Syndromes [Non-FDA Approved]
- 25 mcg/kg IV bolus followed 0.15 mcg/kg/min infusion (reduce infusion rate by 50% if eGFR M 30ml/min)
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- >30 mL/minute: No dose adjustment
- <30 mL/minute: Reduce usual infusion rate by 50%
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Increase in major and minor bleeding events has been reported with the administration of tirofiban. Most of the major bleeding occurs at arterial access sites for cardiac catheterization
- Use tirofiban cautiously in patients with platelet count <150,000/mm3, patients with hemorrhagic retinopathy, and those undergoing chronic hemodialysis
- Caution should be exercised while using tirofiban along with drugs that affect hemostatis
- Patients should be monitored for potential bleeding during treatment with tirofiban. If bleeding is not controlled with pressure, discontinue tirofiban as well as heparin
- Vascular access should be attempted with extreme care to ensure that only the anterior wall of femoral artery is punctured
- Discontinue heparin for 3-4 hrs before pulling the femoral sheath and document activated clotting time (ACT) <180 seconds or activated partial thromboplastin time (APTT) <45 seconds
- Standard compressive techniques followed by close observation should be used to obtain adequate hemostasis after sheath removal. While the sheath is in place, keep the patient on complete bed rest with affected limb restrained in a straight position and the head of the bed elevated 30°. Sheath hemostasis should be achieved at least 4 hrs before discharge
- Minimize other procedures such as arterial and venous punctures, intramuscular injections, epidural procedures, nasotracheal or nasogastric intubation, and urinary catheterization during therapy
- Avoid intravenous access at non-compressible sites such as subclavian or jugular veins
- Monitor platelet counts, hemoglobin and hematocrit before treatment, within 6 hrs of loading dose and once daily thereafter during therapy. If platelet count falls below 90,000/mm3, perform additional platelet counts to exclude pseudothrombocytopenia. If thrombocytopenia is confirmed, discontinue both tirofiban and heparin and initiate appropriate treatment
- Monitor APTT prior to treatment and at regular intervals during treatment. Carefully monitor the anticoagulant effects of heparin by repeated determinations of APTT and adjust the heparin dose accordingly to maintain APTT at approximately 2 times control
Caution: Use cautiously in
Pregnancy Category:B
Breastfeeding: Safety unknown. According to the manufacturer's data, it is not known whether tirofiban is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, analyzing the importance of the drug to the mother.
