tirofiban

High Alert

To reduce the incidence of thrombotic cardiovascular events (death, MI, or refractory ischemia/repeat cardiac procedure) in patients with non-ST elevation acute coronary syndrome (unstable angina/non-ST-elevation MI).

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Active internal bleeding or history of bleeding within previous 30 days;
History of intracranial hemorrhage, intracranial neoplasm, arteriovenous malformation, or aneurysm;
History of thrombocytopenia during previous tirofiban therapy;
History of hemorrhagic stroke or other stroke within 30 days;
Major surgical procedure or severe physical trauma within 30 days;
History, symptoms, or other findings associated with aortic aneurysm;
Severe hypertension (systolic BP >180 mm Hg and/or diastolic BP >110 mm Hg);
Concurrent use of other glycoprotein IIb/IIIa receptor antagonists;
Acute pericarditis.

Use Cautiously in:

Platelet count <150,000/mm³;
Hemorrhagic retinopathy;
Females (↑ risk of bleeding);
Severe renal impairment (↓ rate of infusion if CCr ≤60 mL/min);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: ↑risk of bleeding in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Noted for patients receiving heparin and aspirin in addition to tirofiban

CV: bradycardia, coronary dissection, edema, vasovagal reaction

Derm: hives, rash, sweating

GI: nausea

Hemat: BLEEDING, thrombocytopenia

MS: leg pain

Neuro: headache, dizziness

Misc: fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), pelvic pain

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of aspirin, NSAIDs, warfarin, heparin, heparin-like agents, eptifibatide, clopidogrel, or dipyridamole may ↑ risk of bleeding, although these agents are frequently used together or in sequence.
Risk of bleeding may be ↑ by concurrent use of cefotetan orvalproic acid.

Drug-Natural Products:

↑anticoagulant effect and bleeding risk with anise, arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, licorice, and others.

Availability ⬆ ⬇

(Generic available)

Premixed infusion: 5 mg/100 mL 0.9% NaCl; 12.5 mg/250 mL 0.9% NaCl
Solution for injection: 250 mcg/mL

Route/Dosage ⬆ ⬇

IV (Adults ): 25 mcg/kg within 5 min, then 0.15 mcg/kg/min for up to 18 hr.

Renal Impairment

IV (Adults ): CCr ≤60 mL/min: 25 mcg/kg within 5 min, then 0.075 mcg/kg/min for up to 18 hr.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Decreases platelet aggregation by reversibly antagonizing the binding of fibrinogen to the glycoprotein IIb/IIIa binding site on platelet surfaces.

Therapeutic effects:

Inhibition of platelet aggregation resulting in decreased incidence of new MI, death, or refractory ischemia with the need for repeat cardiac procedures.

Classifications ⬆ ⬇

Therapeutic Classification: antiplatelet agents

Pharmacologic Classification: glycoprotein iib iiia inhibitors

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Excreted mostly unchanged by the kidneys (65%); 25% excreted unchanged in feces.

Half-Life: 2 hr.

Time/Action Profile ⬆ ⬇

(effects on platelet function)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	30 min‡	brief‡

‡>90% inhibition of platelet aggregation at end of initial 30-min infusion.

‡Inhibition is reversible following cessation of infusion.

Patient/Family Teaching ⬆ ⬇

Explain purpose of tirofiban to patient.
Instruct patient to notify health care professional immediately if any bleeding is noted.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇