• 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).

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.

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, (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS , pelvic pain.

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.

(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;

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

Aggrastat

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

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

Therapeutic Classification: antiplatelet agents

Pharmacologic Classification: glycoprotein iib iiia inhibitors

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.

(effects on platelet function)

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

†Inhibition is reversible following cessation of infusion.

• 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.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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