Eptifibatide

Eptifibatide is a prescription medication used for the treatment of acute coronary syndrome (ACS) managed medically or with percutaneous coronary intervention (PCI) and for the treatment of patients undergoing PCI (including intracoronary stenting).

• Eptifibatide is available under the following different brand names: Integrilin

Adult dosage

Injection solution

• 2mg/mL
• 0.75mg/mL

Acute Coronary Syndrome

Adult and geriatric dosage

• 180 mcg/kg IV bolus over 1-2 min, THEN
• 2 mcg/kg/min IV continuous infusion; continue infusion until hospital discharge or the initiation of coronary artery bypass graft surgery (CABG), up to 72 hours
• Patient to undergo PCI: infusion should be continued until hospital discharge or for up to 18- 24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy
• Administer aspirin (160-325 mg) daily

Percutaneous Coronary Intervention

Adult and geriatric dosage

• 180 mcg/kg IV bolus immediately, THEN
• Continuous infusion 2 mcg/kg/min with another 180 mcg/kg IV bolus 10 minutes after 1st bolus
• Continue infusion until hospital discharge, or for up to 18 to 24 hours, whichever comes first; minimum 12 hr infusion recommended
• In patients who undergo CABG surgery, drug infusion should be discontinued before surgery
• Administer aspirin, 160 to 325 mg, 1 to 24 hours before PCI and daily thereafter

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Eptifibatide include:

• bleeding,
• low blood pressure,
• thrombocytopenia, and
• injection site reaction.

Serious side effects of Eptifibatide include:

• easy bruising,
• unusual bleeding from nose, mouth, vagina, or rectum,
• purple or red pinpoint spots under the skin,
• blood in urine,
• black, bloody, or tarry stools,
• coughing up blood or vomit that looks like coffee grounds,
• any bleeding that will not stop,
• sudden numbness or weakness, especially on one side of the body,
• sudden severe headache, confusion, problems with vision, speech, or balance,
• fever, chills, body aches, flu symptoms, and
• feeling like passing out.

Rare side effects of Eptifibatide include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Eptifibatide has severe interactions with the following drug:
  • abrocitinib
• Eptifibatide has serious interactions with the following drugs:
  • antithrombin alfa
  • antithrombin III
  • apixaban
  • argatroban
  • aspirin rectal
  • bivalirudin
  • dalteparin
  • enoxaparin
  • fondaparinux
  • heparin
  • protamine
  • warfarin
• Eptifibatide has moderate interactions with at least 20 other drugs.
• Eptifibatide has minor interactions with the following drugs:
  • devil's claw
  • ginger
  • Ginkgo biloba
  • horse chestnut seed
  • levothyroxine
  • verteporfin

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity
• History of internal bleeding, intracranial hemorrhage or neoplasm, CVA, thrombocytopenia
• AV malformation or aneurysm, aortic dissection, severe HTN, acute pericarditis
• Other parenteral glycoproteins IIb/IIIa inhibitors

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Eptifibatide?”

Long-Term Effects

See “What Are Side Effects Associated with Using Eptifibatide?”

Cautions

Bleeding

• At the site of arterial sheath placement bleeding is the most common complication; minimize the use of arterial and venous punctures, intramuscular injections, and use of urinary catheters, nasotracheal intubation, and nasogastric tubes; when obtaining intravenous access, avoid non-compressible sites (e.g., subclavian or jugular veins)
• Risk factors for bleeding include older age, a history of bleeding disorders, and concomitant use of drugs that increase the risk of bleeding (thrombolytics, oral anticoagulants, nonsteroidal anti-inflammatory drugs, and P2Y12 inhibitors); concomitant treatment with other inhibitors of platelet receptor glycoprotein (GP) IIb/IIIa should be avoided; in patients treated with heparin, bleeding can be minimized by close monitoring of aPTT and ACT
• In patients undergoing PCI, treatment may increase in major and minor bleeding at the site of arterial sheath placement; after PCI, the infusion should be continued until hospital discharge or up to 18 - 24 hours, whichever comes first;
• Heparin use is discouraged after PCI procedure; early sheath removal is encouraged while the drug is being infused; before removing the sheath, it is recommended that heparin be discontinued for 3 to 4 hours and an aPTT of fewer than 45 seconds or ACT less than150 seconds be achieved; in any case, both drugs should be discontinued and sheath hemostasis achieved at least 2 to 4 hours before hospital discharge; if bleeding at access site cannot be controlled with pressure, infusion of both drugs should be discontinued immediately
• Thrombocytopenia
  • There have been reports of acute, profound thrombocytopenia (immune-mediated and non-immune mediated); in the event of acute profound thrombocytopenia or a confirmed platelet decrease to less than 100,000/mm3, discontinue drug and heparin (unfractionated or low-molecular-weight); monitor serial platelet counts, assess the presence of drug-dependent antibodies, and treat as appropriate
  • There has been no clinical experience with therapy initiated in patients with a baseline platelet count below 100,000/mm3; if a patient with low platelet counts is receiving the drug, their platelet count should be monitored closely

Pregnancy and Lactation

• Available data on use in pregnant women from published literature and pharmacovigilance database is insufficient to establish a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes
• Untreated myocardial infarction can be fatal to pregnant women and fetus
• Myocardial infarction is a medical emergency in pregnancy that can be fatal to a pregnant woman and fetus if left untreated; therapy for a pregnant woman should not be withheld because of potential concerns regarding the effects of the drug on the fetus

Lactation

• There are no available data on the presence of the drug in human milk, effects on the breastfed infant, or milk production; as the drug is a peptide, it is likely to be destroyed in an infant’s gastrointestinal tract and not absorbed orally by the breastfed infant