Eptifibatide dosing

Doses and contraindications to glycoprotein Ilb/IIIa receptor blockers are described in Table 5-2. Major bleeding and rates of transfusion are increased with administration of a glycoprotein Ilb/IIIa receptor inhibitor in combination with aspirin and an anticoagulant,30 but there is no increased risk of intracranial hemorrhage in the absence of concomitant fibrinolytic treatment. The risk of thrombocytopenia with tirofiban and eptifibatide appears lower than that with abciximab. Bleeding risks appear similar between agents. 

E. Therapeutic response In human studies, eptifibatide inhibited ex vivo platelet aggregation induced by adenosine diphosphate (ADP) and other agonists in a dose- and concentration-dependent manner. The effect of eptifibatide was observed immediately after administration of a 180pg/kg intravenous bolus. In a placebo-controlled study of patients with acute coronary syndrome, Integrilin reduced the occurrence of death from any cause or new myocardial infarction. Similar benefits were observed in patients undergoing coronary angioplasty. 

Parenteral pre-filled, multiple-dose syringes for SC injection only Eptifibatide (Integrilin)... 

Three intravenous GPIIb/llla inhibitors are currently available for clinical use abciximab, tirofiban, and eptifibatide (4-7). Their mechanisms of action, important differences in pharmacology as well as approved indications and dosing regimens are listed in Table I. 

Brener SJ, Zeymer U, Adgey AA, Vrobel TR, Eptifibatide and low-dose tissue plasminogen activator in acute myocardial infarction. The integrilin and low-dose thrombolysis in acute myocardial infarction (INTRO AMI) trial, J Am Coll Cardiol 2002 39 377. 

In the NICE-3 study (14), 661 ACS patients were treated with enoxaparin SC I mg/kg plus abciximab, eptifibatide, or tirofiban at standard doses. Two strategies were combined for the transition from the ward to the catheter laboratory no interruption and no addition of enoxaparin for PCI within eight hours of the last SC injection and an additive IV bolus of 0.3 mg/kg when PCI was performed between 8 and 12 hours of the last SC injection. The major bleeding rate was 4.5% and the in-hospital death/MI/urgent target vessel revascularization rate was 5.7%. 

Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPIRIT) a randomised placebo-control trial. The Lancet 2000 356, 9247. 

Eptifibatide is indicated for PCI. Dosing is 180 mg/kg bolus followed by a 2.0 mg/kg/min infusion with a second 180 mg/kg bolus 10 minutes after the first bolus for 18-24 hr. 

Yoon et al. retrospectively compared the clinical outcomes of 17 patients who received eptifibatide and rt-PA to an age-matched group of patients who received only rt-PA. The study demonstrated a significantly decreased thrombolytic dose in the combination group (9.0 +/-4.4mgvs. 38.9 +/-30.7 mg) (48). Syed et al. reported that intra-arterial eptifibatide infusion with reteplase can be successful in restoring blood flow in the presence of chronic arterial thrombus (49). 

Low-dose aspirin did not alter the pharmacokinetics or pharmacodynamic effects of ai atroban. Neither abciximab nor eptifibatide appeared to alter ai atroban pharmacokinetics. There is no pharmacodynamic interaction between bivalirudin and aspirin, ticlopidine, ciopidogrei, abciximab, eptifibatide or tirofiban. Nevertheless, the manufacturers warn of the increased bleeding risks if argatroban, bivalirudin or lepirudin are used with antiplatelet drugs or thrombolytics. 

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