Names and pronunciation
(ep-tih-fib′ah-tide) Integrilin
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Drug reference
(ep-tih-fib′ah-tide) Integrilin
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Func. class.: Antiplatelet agent
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Chem. class.: Glycoprotein IIb/IIIa inhibitor
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ACTION: Platelet glycoprotein antagonist; this agent reversibly pre- vents fibrinogen, von Willebrand’s fac- tor from binding to the glycoprotein IIb/IIIa receptor, thus inhibiting plate- let aggregation
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USES: Acute coronary syndrome includ- ing those undergoing percutaneous cor- onary intervention (PCI)
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CONTRAINDICATIONS: Hyper- sensitivity, active internal bleeding; recent history of bleeding, stroke within 30 days or any hemorrhagic stroke; major surgery with severe trauma, severe hypertension, current or planned use of another parenteral GP IIb/IIIa inhibitor, dependence on renal dialysis, coagulopathy, AV malfor- mation, aneurysm Precautions: Pregnancy, breastfeeding, children, geriatric patients, bleeding, impaired renal function
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SIDE EFFECTS CV: Stroke, hypotension GU: Hematuria HEMA: Thrombocytopenia, platelet dys- function SYST: Major/minor bleeding from any site, anaphylaxis
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INTERACTIONS • Do not give with glycoprotein inhibitors IIb, IIIa Increase: bleeding—aspirin, heparin, NSAIDs, anticoagulants, ticlopidine, clop- idogrel, dipyridamole, thrombolytics, valproate, abciximab, SSRIs, SNRIs Drug/Herb Increase: bleeding risk—feverfew, gar- lic, ginger, ginkgo, ginseng
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DOSAGE AND ROUTES Acute coronary syndrome • Adult: IV BOLUS 180 mcg/kg as soon as diagnosed, max 22.6 mg, then IV CONTINUOUS 2 mcg/kg/min until dis- charge or CABG; in CABG discontinue ≥2-4 hr prior to procedure; max infusion rate 15 mg/hr PCI in patients without acute coronary syndrome • Adult: IV BOLUS 180 mcg/kg given immediately prior to PCI, then 2 mcg/ kg/min × 18 hr CONTINUOUS IV IN- FUSION and a second 180-mcg/kg bo- lus by 10 min after first bolus; continue infusion for up to 18-24 hr, minimum 12 hr; max infusion rate 15 mg/hr Renal dose • Adult: IV maintenance CCr <50 mL/ min, 1 mcg/kg/min, max rate 7.5 mg/hr; CCr <10 mL/min, contraindicated
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Available forms: Solution for injection 2 mg/mL (10 mL), 0.75 mg/mL (100 mL) E
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Administer: • Aspirin may be given with this prod- uct; check for bleeding • D/C heparin prior to removing femo- ral artery sheath, after PCI • Do not give discolored solutions, those with particulates; discard unused amount, protect from light • Discontinue product prior to CABG Direct IV route • After withdrawing bolus dose from 20 mg/10 mL (2 mg/mL) vial, give IV push over 1-2 min Continuous IV INFUSION route • Follow bolus dose with continuous infusion using pump; give product undi- luted directly from 100-mL vial, spike 100-mL vial with vented infusion set, use caution when centering spike on circle of stopper top, refrigerate vials, or may store vials ≤2 mo at room temperature Y-site compatibilities: Alfentanil, alteplase, amikacin, aminophylline, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidula- fungin, argatroban, atenolol, atracurium, atropine, azithromycin, aztreonam, bivali- rudin, bumetanide, buprenorphine, butor- phanol, calcium chloride/gluconate, ceFAZolin, cefepime, cefotaxime, cefo- TEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, cip- rofloxacin, cisatracurium, clindamycin, cycloSPORINE, DAPTOmycin, dexametha- sone, D5/NaCl 0.9%, diazepam, dilTIAZem, diphenhydrAMINE, DOBUTamine, dolase- tron, DOPamine, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, ertapenem, erythromycin, esmolol, famoti- dine, fentaNYL, fluconazole, fosphenytoin, ganciclovir, gatifloxacin, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydr OXYzine, imipenem-cilastatin, inamrinone, isoproterenol, ketorolac, labetalol, leucov- orin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, meperidine, meropenem, meth- ylPREDNISolone, metoclopramide, meto- prolol, metroNIDAZOLE, micafungin, midazolam, milrinone, minocycline, mivacurium, morphine, nalbuphine, nalox- one, niCARdipine, nitroglycerin, nitroprus- side, NS, octreotide, ofloxacin, ondanse- tron, oxytocin, palonosetron, pancuronium, PEMEtrexed, PENTobarbital, PHENobarbi- tal, phenylephrine, piperacillin, piperacil- lin-tazobactam, potassium chloride/phos- phates, procainamide, prochlorperazine, promethazine, propranolol, ranitidine, remifentanil, rocuronium, sodium bicar- bonate/phosphates, succinylcholine, SUF- entanil, sulfamethoxazole-trimethoprim, teniposide, theophylline, ticarcillin, ticarcil- lin-clavulanate, tigecycline, tirofiban, tobra- mycin, trimethobenzamide, vancomycin, vecuronium, verapamil, zidovudine, zole- dronic acid
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Assess: • Renal disease: reduce dose if CCr >50; contraindicated in dialysis • Thrombocytopenia: platelets, Hb, Hct, creatinine, APTT baseline within 6 hr of loading dose, daily therafter, patients un- dergoing PCI should have ACT monitored; maintain APTT 50-70 sec unless PCI to be performed; during PCI, ACT should be 200- 300 sec; if platelets drop <100,000/mm3, obtain additional platelet counts; if throm- bocytopenia is confirmed, discontinue product; draw Hct, Hb, serum creatinine • Bleeding: gums, bruising, ecchymosis, petechiae; from GI, GU tract, cardiac cath sites, IM injection sites • Pregnancy/breastfeeding: use in pregnancy only if clearly needed; it is not known if product is excreted in breast milk; consider risks and benefits
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About reason for medication and ex- pected results • To report bruising, bleeding, chest pain immediately • Not to use other Rx, OTC products or supplements without prescriber approval
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PHARMACOKINETICS Onset within 1 hr, protein binding 25%, half-life 1.5-2 hr, steady-state 4-6 hr, metabolism limited, excretion via kidneys
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• Adult: IV BOLUS 180 mcg/kg as soon as diagnosed, max 22.6 mg, then IV CONTINUOUS 2 mcg/kg/min until dis- charge or CABG; in CABG discontinue ≥2-4 hr prior to procedure; max infusion rate 15 mg/hr PCI in patients without acute coronary syndrome
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• Adult: IV BOLUS 180 mcg/kg given immediately prior to PCI, then 2 mcg/ kg/min × 18 hr CONTINUOUS IV IN- FUSION and a second 180-mcg/kg bo- lus by 10 min after first bolus; continue infusion for up to 18-24 hr, minimum 12 hr; max infusion rate 15 mg/hr Renal dose
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• Adult: IV maintenance CCr <50 mL/ min, 1 mcg/kg/min, max rate 7.5 mg/hr; CCr <10 mL/min, contraindicated
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