Two patients experienced a mace during their hospital stay. Adenosine diphosphate adpinduced platelet aggregation returns to nearbaseline levels within 4 to 8 hours. Tirofiban is a generic medicine name and there are several brands available for it. Tirofiban c22h36n2o5s cid 60947 structure, chemical names, physical and.
Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of pharmacy, portland, oregon. Use half normal dose if egfr less than 30 mlminute 1. Tirofiban reference guide for safe and effective use from the american society of. Decreasing renal function was a risk factor for adverse outcomes, with a stepwise increase in ischemic cardiac event rates tables 2 and 3. Tirofiban preserves platelet loss during continuous renal replacement therapy in a randomised prospective openblinded pilot study. Textbook of interventional cardiology 7th edition, elsevier 2012. General renal dosing guidelines agents not listed below click here for a specialized list of other renal medication dosing not listed in the alphabetical main section simple renal dosing guidelines. The information on dosage adjustments in renal impairment given in this book is. We retrospectively analyzed 876 consecutive patients who underwent pci using a single highdose bolus of tirofiban 25 gkg or eptifibatide 180 gkg x 2, 10 minutes apart from january 2003 to august 2005 in a single institution. 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. General renal dosing for healthcare professionals guidelines.
If crcl webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Aggrastat tirofiban hcl side effects, images, uses. A catalogue record for this book is available from the british library. Highdose tirofiban administered as bolusonly during.
Five patients in this analysis had endstage renal disease requiring hemodialysis. Tirofiban is a small molecule inhibitor of the proteinprotein interaction between fibrinogen and the platelet integrin receptor gp iibiiia and is the first drug candidate whose origins can be traced to a pharmacophorebased virtual screening lead. Omega3acid ethyl esters is predicted to increase the risk of bleeding events when given with tirofiban. Tirofiban administered at a bolus dose of 25 mcgkg is associated with a higher level of platelet inhibition compared to that associated with the standard 10 mcgkg tirofiban bolus dose. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Our investigation of highdose bolus tirofiban indicates, for the first time, that the study drug, at the employed regimen, is superior to heparin alone in. The reversible platelet glycoprotein iibiiia receptor inhibitor. Valium, diastat diazepam dosing, indications, interactions. Aggrastat tirofiban hydrochloride dose, indications. Tirofiban 732 tizanidine 733 tobramycin 734 tolbutamide 735 tolfenamic acid 736. Aggrastat injection premixed is supplied as a sterile solution in water for injection, for intravenous use. Failure, loss, and endstage kidney disease criteria grade risk. These pharmacokinetic properties led to an fdaapproved twotiered dosing strategy with a. Tirofiban is removed by hemodialysis and can be used with caution in these patients.
Tirofiban interactions bnfc content published by nice. Following usual bolus dose, initiate constant infusion at 0. In vitro inhibition of platelet aggregation in response to increasing concentrations of tirofiban in patients with significant renal insufficiency article by. In patients with coronary artery disease, the plasma clearance of tirofiban ranges from 152 to 267 mlmin. Tirofiban preserves platelet loss during continuous renal. What is the most important information i should know about tirofiban aggrastat.
Many investigators have suggested that a lower dose of tirofiban be used in patients with chronic renal insufficiency cri to decrease adverse outcomes, the. Aggrastat tirofiban dosing, indications, interactions. Tirofiban is not highly bound to plasma proteins and protein binding is concentration. Tirofiban is a member of the class of piperidines that is ltyrosine in which a hydrogen attached to the amino group is replaced by a butylsulfonyl group and in which the hydrogen attached to the phenolic hydroxy group is replaced by a 4piperidin4ylbutyl group. Pdf tirofiban preserves platelet loss during continuous renal. Tirofiban is cleared from the plasma largely by renal excretion, with about 65% of an administered dose appearing in urine and about 25% in feces, both largely as unchanged tirofiban. Acs tirofiban protocol very high risk acute coronary syndromes addressograph. Dosage adjustment of medications eliminated by the kidneys. Anaphylaxis has been reported in postmarket experience. It has a role as a fibrin modulating drug, a platelet glycoproteiniibiiia receptor antagonist and an anticoagulant. Our investigation of highdose bolus tirofiban indicates, for the first time, that the study drug, at the employed regimen, is superior to heparin alone in highrisk patients undergoing pci, dr. Some of the brands for tirofiban might be better known than tirofiban itself. The authors make no claims of the accuracy of the information contained herein.
Tirofiban is indicated for use in acs managed medically or with. Feb 18, 2019 provides accurate and independent information on more than 24,000 prescription drugs, overthecounter medicines and natural products. Aggrastat tirofiban hydrochloride injection premixed 9123301 aggrastat tirofiban hydrochloride injection 2 concentration during the infusion. Find patient medical information for tirofiban in 0. Administer intravenously 25 mcgkg within 5 minutes and then 0. In this study,we attempted to find the in vitro concentration of tirofiban required to inhibit platelet aggregation to 6 wk but book is available from the british library. In combination with unfractionated heparin, aspirin, and clopidogrel for prevention of early myocardial infarction in patients with unstable angina or nonstsegmentelevation myocardial infarction nstemi and with last episode of chest pain within 12 hours with angiography planned for 448 hours after diagnosis initiated under specialist supervision. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. The reversible platelet glycoprotein iibiiia receptor inhibitor tirofiban was. The plasma clearance of tirofiban in patients with coronary heart disease is similar in men. Tirofiban inn, trade name aggrastat is an antiplatelet drug. In healthy subjects the plasma clearance of tirofiban is about 250 mlmin.
An unwanted blood clot can occur with certain heart or blood vessel conditions. Tirofiban is primarily eliminated through renal excretion, so dose adjustments are needed. Despite the benefits seen in using enoxaparin rather than ufh in treating vte, enoxaparins relatively high degree of renal excretion raises a concern for drug accumulation and a commensurate increased bleeding risk in patients with renal impairment. There is no effect on clearance of tirofiban by sex, race, age, or hepatic impairment. 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. The median time from stent implantation to dapt interruption was 33 days range 3146 days.
The renal drug handbook the st georges hospital, adult critical. What should i discuss with my health care provider before receiving tirofiban aggrastat. Reduce the dose in patients with severe renal insufficiency. Jan 30, 2018 renal and biliary excretion contribute significantly to the elimination of tirofiban. Aggrastat concentrate for infusion is a sterile concentrated solution for intravenous infusion after dilution and is supplied in a 50 ml glass vial. Tirofiban hydrochloride monohydrate is a white to offwhite, nonhygroscopic, freeflowing powder, with a molecular weight of 495.
Drugs az pill identifier supplements symptom checker diseases dictionary media. Specifically, eptifibatide is contraindicated and tirofiban is not defined in patients undergoing dialysis. In this study,we attempted to find the in vitro concentration of tirofiban required to inhibit platelet aggregation to nov 09, 2018 tirofiban helps to prevent platelets in your blood from sticking together and forming a blood clot. It is cleared from the plasma largely by renal excretion, with about 65% of an administered dose appearing in urine and about 25% in feces, both largely as unchanged ti rofiban. Aggrastat 50 mcgml solution for infusion summary of. If the pharmacy thats willing to deliver medicines to your home doesnt have tirofiban in stock, you can ask for one of the branded alternatives for tirofiban. Benefits and safety of tirofiban among acute coronary. Aggrastat tirofiban hydrochloride injection is an acutecare, hospitalbased cardiovascular pharmaceutical aggrastat is accahascai class i recommended view guidelines. May 22, 2019 tirofiban has a halflife of approximately 2 hours. Drug dosing adjustments in patients with chronic kidney.
Irrespective of renal function, this increased risk was significantly reduced by the combination of tirofibanheparin versus heparin alone. Platelet aggregation tirofiban renal insufficiency. It is cleared from the plasma largely by renal excretion, with about 65% of an administered dose appearing in urine and about 25% in feces, both largely as unchanged tirofiban. Do not add other drugs or remove solution directly from the intravia bag with a syringe. Percutaneous coronary intervention, intraaortic balloon pump, and continuous renal replacement therapy crrt require effective antiplatelet therapy and anticoagulation, resulting in a high risk for platelet loss and bleeding events. Tirofiban is indicated for the prevention of major cardiovascular events in adult patients presenting with acute coronary syndromes without st elevation nsteacs with the last episode of chest pain occurring within 12 hours and with ecg changes andor elevated cardiac enzymes. The information on dosage adjustments in renal impairment given in this book is based on cockcroftgault creatinine clearance and not egfr, since the majority. Switching from eptifibatide to tirofiban use in acs. Oslerphile, emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Renal dosage adjustment guidelines for antimicrobials. According to the manufacturers recommendations for severe renal insufficiency creatinine clearance of less than 30 mlminute, patients of the tirofiban group received, in addition to ufh, tirofiban by intravenous bolus application of 0. The clearance of tirofiban in patients with severe renal impairment or renal failure is decreased approximately 40% in patients with a crcl less than 60 mlminute and more than 50% in patients with a crcl less than 30 mlminute, including those requiring hemodialysis.
Severe trauma or surgery 6 wk but renal and mild to moderate hepatic impairment. It belongs to a class of antiplatelet named glycoprotein iibiiia inhibitors. Pharmacokinetic evaluation of tirofiban using a single. Aug 29, 2008 approximately one third of all patients with cardiogenic shock suffer from acute kidney injury. Of particular interest is the optimal dosing of glycoprotein iibiiia inhibitors in the setting of acute myocardial infarction. As a consequence, a dosage adjustment of 50% of the tirofiban label dosing regimen 0. Aggrastat prescription and dosage sizes information for physicians and. In patients with renal impairment creatinine clearance less than 30 ml per minute. Tirofiban is an intravenously administered nonpeptide glycoprotein iibiiia receptor antagonist which specifically inhibits fibrinogendependent platelet aggregation and prolongs bleeding times in patients with acute coronary syndromes. Drug dosing adjustments in patients with chronic kidney disease myrna y.
Pharmacokinetic evaluation of tirofiban using a single high. What are the possible side effects of tirofiban aggrastat. Withdraw 50 ml infusion fluid from 250 ml bag and replace with 50 ml tirofiban concentrate 250 microgramsml to give a final concentration of 50 microgramsml. 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. Tirofiban aggrastat weight dose chart bolus dosing renal dysfunction bolus 0. Aggrenox aspirinextendedrelease dipyridamole capsules.