Names and pronunciation
(tie-roh-fee′ban) Aggrastat
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Drug reference
(tie-roh-fee′ban) Aggrastat
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Func. class.: Antiplatelet T
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Chem. class.: Glycoprotein IIb/IIIa inhibitor
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Do not confuse: Aggrastat/argatroban
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ACTION: Antagonist of platelet glycoprotein (GP) IIb/IIIa receptor that prevents binding of fibrinogen and von Willebrand’s factor, which inhibits platelet aggregation
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USES: Acute coronary syndrome in combination with heparin
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CONTRAINDICATIONS: Hyper- sensitivity, active internal bleeding, stroke, major surgery, severe trauma within 30 days, intracranial neoplasm, aneurysm, hemorrhage, acute pericarditis, platelets <100,000/mm3, history of thrombo cytopenia, coagulopathy, systolic B/P >180 mm Hg or diastolic B/P >110 mm Hg Precautions: Pregnancy, breastfeeding, children, geriatric patients, renal dis- ease, bleeding tendencies, hypertension, platelets <150,000/mm3
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SIDE EFFECTS CNS: Dizziness, headache CV: Bradycardia, hypotension, edema GI: Nausea, vomiting, GI hemorrhage HEMA: Bleeding, thrombocytopenia INTEG: Rash MISC: Dissection, edema, pain in legs/ pelvis, sweating SYST: Anaphylaxis PHARMOCOKINETICS Half-life 2 hr; excretion via urine, feces; plasma clearance 20%-25% lower in geriatric patients with CAD; renal insuffi- ciency decreases plasma clearance
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INTERACTIONS Increase: bleeding—aspirin, heparin, NSAIDs, abciximab, eptifibatide, clopi- dogrel, ticlopidine, dipyridamole, cefa- mandole, cefoTEtan, cefoperazone, val- proic acid, heparins, thrombin inhibitors, SSRIs, SNRIs Increase: tirofiban clearance—levothy- roxine, omeprazole Drug/Lab Decrease: platelets, Hct, HB
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DOSAGE AND ROUTES • Adult: IV 25 mcg/kg within 5 min, then 0.15 mcg/kg/min for up to 18 hr after Renal dose • Adult: IV CCr <60 mL/min, 25 mcg/kg, then 0.075 mcg/kg/min
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Available forms: Inj 50-mL vials; inj premixed bag 50 mcg/mL in 100, 250 mL
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Administer: Intermittent IV INFUSION route • Discontinue no less than 2-4 hr before CABG • Do not use if particulates are present • Dilute inj: withdraw and discard 100 mL from 500-mL bag of sterile 0.9% NaCl or D5W and replace this vol with 100 mL of tirofiban inj from 2 vials • Tirofiban inj for sol is premixed in containers of 500 mL 0.9% NaCl (50 mg/ mL), infuse over 30 min • Minimize other arterial/venous punc- tures, IM inj, catheter use, intubation to reduce bleeding risk • Discard unused solution after 24 hr from start of infusion Y-site compatibilities: Acyclovir, alfentanil, allopurinol, amifostine, amikacin, amino- caproic acid, aminophylline, amiodarone, ampicillin, ampicillin/sulbactam, anidula- fungin, argatroban, arsenic trioxide, atracu- rium, atropine, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, capreomycin, CARBO- platin, carmustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlor- proMAZINE, cimetidine, ciprofloxacin, cis- atracurium, CISplatin, clindamycin, cyclo- phosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexametha- sone, dexmedetomidine, dexrazoxane, digoxin, diltiaZEM, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, DOXOrubicin, DOXOrubicin liposome, doxycycline, dro- peridol, enalaprilat, ePHEDrine, EPINEPH- rine, epiRUBicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etopo- side phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluoro- uracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glyco- pyrrolate, granisetron, haloperidol, hepa- rin, hydrALAZINE, hydrocortisone, HYDRO- morphone, IDArubicin, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucov- orin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechloretha- mine, melphalan, meperidine, merope- nem, mesna, methylhexital, methotrexate, methyldopate, methylPREDNISolone, meto- clopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoXANTRONE, morphine, mycophenolate, nafcillin, nalbu- phine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepineph- rine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pami- dronate, pancuronium, pantoprazole, PEMEtrexed, PENTobarbital, PHENobarbi- tal, phentolamine, phenylephrine, piper- acillin/tazobactam, potassium acetate, potassium chloride/phosphates, procain- amide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, raNITIdine, remifentanil, rocuronium, sodium acetate/bicarbonate, streptozocin, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiopental, thio- tepa, ticarcillin/clavulanate, tigecycline, tobramycin, topotecan, vancomycin, vaso- pressin, vecuronium, verapamil, vinBLAS- tine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
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Assess: • Bleeding: platelet counts, Hct, HB before treatment, within 6 hr of load ing dose, and at least daily thereafter; watch for bleeding from puncture sites, catheters; or in stools, urine; discontinue if platelets (100 × 10 9/L); if platelets (<90 × 10 9/L) additional platelet counts should be performed to exclude pseudo thrombocytopenia; if thrombocytopenia is confirmed, tirofiban and heparin should be discontinued • Assess for contraindications to ther- apy: recent major surgery, active bleed- ing, peptic ulcer disease, trauma within 30 days • Pregnancy/breastfeeding: do not use unless clearly needed; do not breastfeed, excretion unknown
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Evaluate: • Therapeutic response: treatment of acute coronary syndrome
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That it is necessary to quit smoking to prevent excessive vasoconstriction • About signs, symptoms of bleeding and low platelets; report bleeding (blood in stool/urine) to prescriber; use mechani- cal razors, soft-bristle toothbrush • That there are many product and herbal interactions; do not use unless approved by prescriber HIGH ALERT
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• Adult: IV 25 mcg/kg within 5 min, then 0.15 mcg/kg/min for up to 18 hr after Renal dose
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• Adult: IV CCr <60 mL/min, 25 mcg/kg, then 0.075 mcg/kg/min
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