See renal impairment under dosage and administration. How to manage the renal patient with coronary heart. Clearance in patients with coronary artery disease is about 55 mlkgh. Drug information on integrilin eptifibatide includes side effects, uses, drug interactions, dosage, drug pictures, overdose symptoms, and what to avoid. Proceed to complete the diagnostic cardiac catheterization. Withdraw the bolus dose s of integrilinfrom the 10ml vial into a syringe. Safety and efficacy of adjusted dose eptifibatide in patients with acute coronary syndromes and reduced renal function. Insufficient data exist to recommend a specific dose adjustment in pediatric patients with renal impairment. When a dosing range is indicated in the tables below e. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Clinical pharmacology of eptifibatide sciencedirect.
Renal function was calculated using both ideal and actual body weights of patients. Aug 26, 2019 although there has been no clinical experience on the use of eptifibatide in patients on dialysis, in vitro studies suggest it is not extensively bound to plasma proteins and thus may be cleared from plasma by dialysis. Assessment of eptifibatide dosing in renal impairment before and after inservice education provided by pharmacists. Baraclude entecavir dosing, indications, interactions. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020, wolters kluwer updated. Administer integrilinby volume according to patient weightsee table1. If the oral route is not an option, weigh the benefits and potential risks when considering iv therapy. Welcome to the fifth edition of the renal drug handbook.
Dosing continuous renal replacement therapies crrt. With either vehicle, the infusion may also contain up to 60 meql of potassium chloride. Pdf adjusting eptifibatide doses for renal impairment. Adult drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous. Drug dosing adjustments in patients with chronic kidney disease. Only if clinically necessary, restart iv heparin or sq enoxaparin 4 hours after sheath removal. In patients with moderate to severe renal insufficiency crcl. The authors explore efficacy and safety outcomes in multiple degrees of renal impairment when using fdaapproved dosing regimens for enoxaparin and find that a more multitiered dosing strategy appears to be needed. If weight greater than or equal to 70 kg, 5000unit bolus followed by infusion of unitsh. Nov 01, 2019 integrilin should be given concomitantly with heparin dosed to achieve the following parameters. Pletal cilostazol dose, indications, adverse effects.
Integrilin eptifibatide dosing, indications, interactions. Highlights of prescribing information coadministration of. Specifically, eptifibatide is contraindicated and tirofiban is not defined in patients undergoing dialysis. The level of renal function below which the dose of a drug must be reduced depends largely on the extent of renal metabolism and elimination, and on the drugs toxicity. The extent of eptifibatide binding to human plasma protein is about 25%. The use of eptifibatide is illadvised for people that have thrombocytopenia, renal insufficiency, geriatric patients, pediatric patients below 18 years of age. Immediately stop infusion of eptifibatide and heparin if bleeding at the arterial access site cannot be controlled by pressure. Adjust kengreal dose based on patient weight to meet the recommended 30 mcgkg iv bolus and 4 mcgkgmin iv infusion. Safety and efficacy of adjusteddose eptifibatide in patients. When administered alone, eptifibatide has no measurable effect on pt or aptt. Assessment of eptifibatide dosing in renal impairment before.
May administer eptifibatide in the same intravenous line as alteplase, atropine, dobutamine, heparin, lidocaine, meperidine, metoprolol, midazolam, morphine, nitroglycerin, or verapamil. Find patient medical information for integrilin intravenous on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Dosing guidelines book school of medicine university of. Total drug clearance is decreased by approximately 50% and steadystate plasma integrilin concentrations are doubled in patients with an estimated crcl renal dose adjustment guidelines for antimicrobials. When using an intravenous infusion pump, administer integrilin undiluted directly from the 100ml vial. Because of the renal elimination and increased risk for bleeding events at supratherapeutic doses of eptifibatide, the manufacturer recommends dosing adjustment in patients with renal. Refer to the prescribing information for infusion volume to be administered based on patient weight, dose prescribed, and concentration of vial. Integrilin eptifibatide dose, indications, adverse effects. Integrilin eptifibatide dose, indications, adverse. Dosing guidelines book dosing guidelines for children dosing guidelines for adults. Eptifibatide is sometimes given around the clock for up to 4 days in a row. Safety and efficacy of adjusteddose eptifibatide in patients with acute coronary syndromes and reduced renal function article in american heart journal 1625. Integrilin etifibatide injection etifibatide injection.
Eptifibatide is injected into a vein through an iv. Adult drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in. Consider dose reductions or dosing interval increases similar to adult adjustments. A novel dosing regimen was suggested for eptifibatide in planned coronary stent implantation. For oncedaily dosing, draw a single random level 8 to 12 hours after dose given adjustments are made based on a published hartford nomogram. Assessment of eptifibatide dosing in renal impairment before and. Eptifibatide 274 erlotinib 275 ertapenem 276 erythromycin 277 escitalopram 279. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Safety and effectiveness of teflaro for the treatment of absssi in pediatric patients less than 34 weeks gestational age and less than 12 days postnatal age have not been established. Following a single iv dose of 14cradiolabeled eptifibatide 5 ugkg in healthy men, renal clearance averaged approximately 4050% of total body clearance. Eptifibatide is cleared by both renal and nonrenal mechanisms, with renal clearance accounting for approximately 40% of total body clearance. Clearance is reduced by 50% in patients with moderate to severe renal impairment estimated clcr less than 50 mlminute. Drug dosing adjustments in patients with chronic kidney.
Following a single iv dose of 14 cradiolabeled eptifibatide 5 ugkg in healthy men, renal clearance averaged approximately 4050% of total body clearance. Renal functionbased dose adjustments adult inpatient. Find patient medical information for eptifibatide intravenous on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Eptifibatide is available in 100ml vials containing either 0. Renal dosage adjustment guidelines for antimicrobials the pharmacists will automatically adjust the doses of any of the antimicrobials included in the protocol according to the estimated creatinine clearance generally using the cockroftgault equation for patients. Moderate because cilostazol is a platelet aggregation inhibitor, a potential additive risk for bleeding exists if cilostazol is given with other agent that affect hemostasis such as platelet glycoprotein iibiiia inhibitors including abciximab, eptifibatide, and tirofiban. Approximately 50% of eptifibatide is cleared by the kidney in patients with normal renal function.
Center the spike within the circle on the stopper top. Eptifibatide is a platelet aggregation inhibitor that prevents plateletsspecialized blood cellsfrom sticking together and clotting. Find information on eptifibatide integrilin in daviss drug guide including dosage. Guidelines for use of fondaparinux anticoagulation services. Eptifibatide is contraindicated in patients with any of the following. In healthy subjects, renal clearance accounts for approximately 50% of total body clearance, with the majority of the drug excreted in the urine as eptifibatide, deaminated eptifibatide, and other. An interchain disulfide bridge is formed between the cysteine amide and the mercaptopropionyl moieties. Renal dosing modifications are intended to maximize outcomes through the establishment and maintenance of therapeutic drug concentrations, and minimize toxicity that may result from excessive accumulation of the drug or its metabolites. Renal insufficiency approximately 50% of eptifibatide is cleared by the kidney in patients with normal renal function. Eptifibatide accord is intended for use with acetylsalicylic acid and unfractionated heparin. A catalogue record for this book is available from the british library. Immediately following the bolus dose administration, initiate a continuous infusion of. Take on empty stomach 2 hr ac or pc use oral solution for children weighing 1030 kg.
Guidelines for the use of eptifibatide integrilin in acute coronary syndrome cardiovascular clinical program july2008 dosage and administration of eptifibatide diagnostic cardiac catheterization 1. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents. Inspect eptifibatide for particulate matter and discoloration prior to administration, whenever solution and container permit. Study results edit eptifibatide was licensed due to the positive results of the socalled pursuit study encompassing 10,948 patients.
Drug dosing adjustments in patients with chronic kidney disease myrna y. To better understand continuous renal replacement therapies crrt, we must understand the process of solute removal by diffusion and convection. Donovan jl1, schroeder ws, tran mt, foster k, forrest a, lee tb, gandhi pj. Novel dosing regimen of eptifibatide in planned coronary stent implantation esprit. Some of the brands for eptifibatide might be better known than eptifibatide itself. Integrilin eptifibatide injection is a clear, colorless, sterile, nonpyrogenic solution for intravenous iv use. Continue eptifibatide for at least 1824 hours after the procedure. Refrain use in case you have allergy to any of the ingredients or if you suffer from hypertension. Dec 26, 2017 the eptifibatide dosing regimen used in the esprit study included two 180 mcgkg bolus doses given 10 minutes apart combined with a continuous 2 mcgkgmin infusion. Renal impairment in patients with moderate to severe renal insufficiency crcl eptifibatide is reduced by approximately 50% and steadystate plasma levels approximately doubled see use in specific populations 8. The infusion doses used in this study had only a modest effect on the simplate bleeding times.
This book is distributed under the terms of the creative commons. If the pharmacy thats willing to deliver medicines to your home doesnt have eptifibatide in stock, you can ask for one of the branded alternatives for eptifibatide. Teflaro should only be used if the potential benefit justifies the potential risk in these populations. Eptifibatide is an antiplatelet drug which reversibly binds and inhibits glycoprotein iibiiia receptor of platelets. Safety and efficacy of adjusteddose eptifibatide in. Total drug clearance is decreased by approximately 50% and steadystate plasma eptifibatide concentrations are doubled in patients with an estimated creatinine clearance eptifibatide dosage information for adults. Eptifibatide may be administered in the same iv line with ns or d5ns. Dialysis, renal disease, renal failure, renal impairment in patients with renal disease, renal function should be assessed prior to eptifibatide therapy. Withdraw the bolus dose s of integrilin from the 10ml vial into a syringe. Continue heparin or enoxaparin, continue eptifibatide. Dose adjustments do not appear to be necessary for patients with mild to moderate renal impairment i. Renal dosage adjustment guidelines for antimicrobials. Nov 28, 2018 integrilin eptifibatide injection solution for intravenous use. Includes dosages for myocardial infarction, angina pectoris, acute coronary syndrome and more.
One study retrospectively evaluated 355 patients on dabigtran and rivaroxaban for appropriateness of dosing based on the package insert recommendations for renal insufficiency. In patients with moderate to severe renal insufficiency crcl eptifibatide is reduced by approximately 50% and steadystate plasma levels approximately doubled see use in specific populations 8. Eptifibatide injection integrilin side effects, medical. Dose adjustment is not required in elderly patients. Read more about the prescription drug eptifibatide injection. The level of renal function below which the dose of a drug must be reduced depends largely on the extent of renal metabolism and elimination, and on the drugs. Baseline and prn if change in renal function is suspected or if bleeding is suspected or confirmed, and hold dosing as needed long term monitoring guidelines for fondaparinux patient weight. Eptifibatide is a cyclic heptapeptide containing 6 amino acids and 1 mercaptopropionyl desamino cysteinyl residue. Because of the renal elimination and increased risk for bleeding events at supratherapeutic doses of eptifibatide, the manufacturer recommends dosing adjustment in patients with renal dysfunction. Eptifibatide is eliminated via renal excretion, so dose adjustment is recommended with a creatinine clearance of less than 50 mlmin 2,64. Guidelines for the use of eptifibatide integrilin in.
A protein found in the venom of a southeastern pygmy rattlesnake is used to make eptifibatide. Dec 29, 2019 the eptifibatide dosing regimen used in the esprit study included two 180mcgkg bolus doses given 10 minutes apart combined with a continuous 2mcgkgmin infusion. Immediately following the bolus dose administration, initiate a continuous infusion of integrilin. When using an intravenous infusion pump, administer integrilin undiluted directly from. It belongs to the class of the argininglycinaspartatmimetics and reversibly binds to platelets. The renal drug handbook the st georges hospital, adult critical. The recommended adult dosage of eptifibatide in patients with acute coronary syndrome and. Diffusion is the process by which molecules that are present in a solvent and can pass freely across. The role of the nurse in treating patients with integrilin. Remove the bolus from the iv bag, never from the reconstituted vial. Perform platelet transfusions 10pack initially as required to control bleeding. Eptifibatide side effects, dosage, interactions drugs.
Safety and efficacy of adjusteddose eptifibatide in patients with acute coronary syndromes and reduced renal function. Tirofiban is cleared from the plasma largely by renal excretion. Assessment of eptifibatide dosing in renal impairment before and after inservice education provided by. Eptifibatide reference guide for safe and effective use from the american society of healthsystem. Eptifibatide integrilin, millennium pharmaceuticals, also copromoted by scheringploughessex, is an antiplatelet drug of the glycoprotein iibiiia inhibitor class. Eptifibatide should not be used in patients with renal failure and is contraindicated in patients with dependency on renal dialysis. Eptifibatide is a generic medicine name and there are several brands available for it. If you are receiving this injection during an angioplasty procedure, the medicine will be given throughout the entire procedure and for up to 24 hours after the procedure. Achieve hemostasis at the arterial access site by standard compression for a minimum of 4 h prior to hospital discharge following discontinuation of eptifibatide and heparin.
The information on dosage adjustments in renal impairment given in this book is. The pursuit and impactii account for the indications of eptifibatide by food and drug administrationfdaas mentioned below. Baxters cardiovascular medicine eptifibatide approved by fda drugs targeting arterial thrombi include the antiplatelet drugs aspirin, clopidogrel, abciximab, eptifibatide and tirofiban and the fibrinolytics. Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of pharmacy, portland, oregon. Consumer information about the medication eptifibatide injection integrilin, includes side effects, drug interactions, recommended dosages, and storage information. Use of eptifibatide is considered contraindicated in patients who are dependent on renal dialysis. Switching from eptifibatide to tirofiban use in acs. Each 10ml vial contains 2 mgml of eptifibatide and each 100ml vial contains either 0. Integrilin eptifibatide uses, side effects, dosage.
Novel dosing regimen of eptifibatide in planned coronary. Guidelines for the use of eptifibatide integrilin in acute. Eptifibatide definition of eptifibatide by medical. If you have moderate renal dysfunction, dosing of these agents must be adjusted, and if you have severe renal dysfunction, then tirofiban and eptifibatide should probably not be used at all. Eptifibatide definition of eptifibatide by medical dictionary. Detailed eptifibatide dosage information for adults. Nov 09, 2018 eptifibatide is injected into a vein through an iv. Integrilin is cleared in part by the kidney and its plasma concentrations are doubled in patients with renal disease creatinine clearance dose of integrilin needs to be reduced to 1 mcgkgmin in these patients. Eptifibatide is a cyclic heptapeptide derived from a disintegrin protein found in the venom of the southeastern pygmy rattlesnake sistrurus miliarius barbouri. Dosing regimens should be tailored based on presumed source of infection, mic data when available, and residual renal function. Esprit was a randomized, placebocontrolled trial that evaluated the use of eptifibatide in elective pci.
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