Eptifibatide instructions for administration

List of indications
General Acute Coronary Syndrome Percutaneous Coronary Intervention (PCI) Aspirin and Heparin Dosing Recommendations
 * Acute Coronary Syndrome
 * PCI

Instructions for Eptifibatide Administration

General
The safety and efficacy of eptifibatide has been established in clinical studies that employed concomitant use of heparin and aspirin. Different dose regimens of eptifibatide were used in the major clinical studies.

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Acute Coronary Syndrome
The recommended adult dosage of eptifibatide in patients with acute coronary syndrome and normal renal function is an intravenous bolus of 180 µg/kg as soon as possible following diagnosis, followed by a continuous infusion of 2.0 µg/kg/min until hospital discharge or initiation of CABG surgery, up to 72 hours. If a patient is to undergo a percutaneous coronary intervention (PCI) while receiving eptifibatide, the infusion should be continued up to hospital discharge, or for up to 18 to 24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy.

Patients with Creatinine Clearance <50 mL/min
The recommended adult dosage of eptifibatide in patients with acute coronary syndrome with an estimated creatinine clearance (using the Cockcroft-Gault equation)1 <50 mL/min is an intravenous bolus of 180 µg/kg as soon as possible following diagnosis, immediately followed by a continuous infusion of 1.0 µg/kg/min.

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Percutaneous Coronary Intervention (PCI)
The recommended adult dosage of eptifibatide in patients with normal renal function is an intravenous bolus of 180 µg/kg administered immediately before the initiation of PCI followed by a continuous infusion of 2.0 µg/kg/min and a second 180-µg/kg bolus 10 minutes after the first bolus. Infusion should be continued until hospital discharge, or for up to 18 to 24 hours, whichever comes first. A minimum of 12 hours of infusion is recommended.

Patients with Creatinine Clearance <50 mL/min
The recommended adult dose of eptifibatide in patients with an estimated creatinine clearance (using the Cockcroft-Gault equation)1 <50 mL/min is an intravenous bolus of 180 µg/kg administered immediately before the initiation of the procedure, immediately followed by a continuous infusion of 1.0 µg/kg/min and a second 180-µg/kg bolus administered 10 minutes after the first.

In patients who undergo coronary artery bypass graft surgery, eptifibatide infusion should be discontinued prior to surgery.



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Aspirin and Heparin Dosing Recommendations
In the clinical trials that showed eptifibatide to be effective, most patients received concomitant aspirin and heparin. The recommended aspirin and heparin doses to be used are as follows:

Aspirin

 * 160 to 325 mg orally initially and daily thereafter

Heparin

 * Target aPTT 50 to 70 seconds during medical management


 * If weight ≥70 kg, 5000 U bolus followed by infusion of 1000 U/hr.


 * If weight <70 kg, 60 U/kg bolus followed by infusion of 12 U/kg/hr.


 * Target ACT 200 to 300 seconds during PCI


 * If heparin is initiated prior to PCI, additional boluses during PCI to maintain an ACT target of 200 to 300 seconds.
 * Heparin infusion after the PCI is discouraged.

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Aspirin

 * 160 to 325 mg orally 1 to 24 hours prior to PCI and daily thereafter

Heparin

 * Target ACT 200 to 300 seconds


 * 60 U/kg bolus initially in patients not treated with heparin within 6 hours prior to PCI.
 * Additional boluses during PCI to maintain ACT within target.
 * Heparin infusion after the PCI is strongly discouraged.

Patients requiring thrombolytic therapy should have eptifibatide infusions stopped.

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Instructions for Eptifibatide Administration

 * Like other parenteral drug products, Integrilin® solutions should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
 * Integrilin® may be administered in the same intravenous line as alteplase, atropine, dobutamine, heparin, lidocaine, meperidine, metoprolol, midazolam, morphine, nitroglycerin, or verapamil. Integrilin® should not be administered through the same intravenous line as furosemide.
 * Integrilin® may be administered in the same IV line with 0.9% NaCl or 0.9% NaCl/5% dextrose. With either vehicle, the infusion may also contain up to 60 mEq/L of potassium chloride. No incompatibilities have been observed with intravenous administration sets. No compatibility studies have been performed with PVC bags.
 * The bolus dose(s) of Integrilin® should be withdrawn from the 10-mL vial into a syringe. The bolus dose(s) should be administered by IV push.
 * Immediately following the bolus dose administration, a continuous infusion of Integrilin® should be initiated. When using an intravenous infusion pump, Integrilin® should be administered undiluted directly from the 100-mL vial. The 100-mL vial should be spiked with a vented infusion set. Care should be taken to center the spike within the circle on the stopper top.

Integrilin® is to be administered by volume according to patient weight. Patients should receive Integrilin® according to the following table:



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