Drugs az pill identifier supplements symptom checker diseases dictionary media. In patients with renal impairment creatinine clearance less than 30 ml per minute. What are the possible side effects of tirofiban aggrastat. 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. 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. 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. Tirofiban is not highly bound to plasma proteins and protein binding is concentration. Tirofiban aggrastat weight dose chart bolus dosing renal dysfunction bolus 0.
In patients with coronary artery disease, the plasma clearance of tirofiban ranges from 152 to 267 mlmin. 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. In healthy subjects the plasma clearance of tirofiban is about 250 mlmin. Some of the brands for tirofiban might be better known than tirofiban itself. Decreasing renal function was a risk factor for adverse outcomes, with a stepwise increase in ischemic cardiac event rates tables 2 and 3. These pharmacokinetic properties led to an fdaapproved twotiered dosing strategy with a. Aggrastat tirofiban hcl side effects, images, uses. Failure, loss, and endstage kidney disease criteria grade risk. Adenosine diphosphate adpinduced platelet aggregation returns to nearbaseline levels within 4 to 8 hours. The information on dosage adjustments in renal impairment given in this book is based on cockcroftgault creatinine clearance and not egfr, since the majority. Highdose tirofiban administered as bolusonly during. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry.
Administer intravenously 25 mcgkg within 5 minutes and then 0. Do not add other drugs or remove solution directly from the intravia bag with a syringe. 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 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. Tirofiban c22h36n2o5s cid 60947 structure, chemical names, physical and. There is no effect on clearance of tirofiban by sex, race, age, or hepatic impairment. 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. Drug dosing adjustments in patients with chronic kidney disease myrna y. In vitro inhibition of platelet aggregation in response to increasing concentrations of tirofiban in patients with significant renal insufficiency article by. As a consequence, a dosage adjustment of 50% of the tirofiban label dosing regimen 0.
What is the most important information i should know about tirofiban aggrastat. Tirofiban inn, trade name aggrastat is an antiplatelet drug. Oslerphile, emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Pharmacokinetic evaluation of tirofiban using a single high. The renal drug handbook the st georges hospital, adult critical. The median time from stent implantation to dapt interruption was 33 days range 3146 days. Safety and efficacy have not been established in patients younger than 18 years. Renal dosage adjustment guidelines for antimicrobials. A catalogue record for this book is available from the british library. Aug 29, 2008 approximately one third of all patients with cardiogenic shock suffer from acute kidney injury.
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. 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. May 22, 2019 tirofiban has a halflife of approximately 2 hours. It belongs to a class of antiplatelet named glycoprotein iibiiia inhibitors. Textbook of interventional cardiology 7th edition, elsevier 2012.
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. Severe trauma or surgery 6 wk but renal and mild to moderate hepatic impairment. Pharmacokinetic evaluation of tirofiban using a single. Drug dosing adjustments in patients with chronic kidney. An unwanted blood clot can occur with certain heart or blood vessel conditions. Irrespective of renal function, this increased risk was significantly reduced by the combination of tirofibanheparin versus heparin alone. Use half normal dose if egfr less than 30 mlminute 1. Platelet aggregation tirofiban renal insufficiency.
Pdf tirofiban preserves platelet loss during continuous renal. 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. The reversible platelet glycoprotein iibiiia receptor inhibitor tirofiban was. Specifically, eptifibatide is contraindicated and tirofiban is not defined in patients undergoing dialysis. Tirofiban preserves platelet loss during continuous renal replacement therapy in a randomised prospective openblinded pilot study. General renal dosing for healthcare professionals guidelines. Omega3acid ethyl esters is predicted to increase the risk of bleeding events when given with tirofiban. 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. 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. Of particular interest is the optimal dosing of glycoprotein iibiiia inhibitors in the setting of acute myocardial infarction. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.
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. 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. Anaphylaxis has been reported in postmarket experience. What should i discuss with my health care provider before receiving tirofiban aggrastat. Tirofiban is indicated for use in acs managed medically or with. Aggrastat concentrate for infusion is a sterile concentrated solution for intravenous infusion after dilution and is supplied in a 50 ml glass vial. Tirofiban reference guide for safe and effective use from the american society of. 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. Aggrastat prescription and dosage sizes information for physicians and.
Tirofiban preserves platelet loss during continuous renal. Switching from eptifibatide to tirofiban use in acs. The plasma clearance of tirofiban in patients with coronary heart disease is similar in men. Aggrastat tirofiban hydrochloride dose, indications. Valium, diastat diazepam dosing, indications, interactions.
Aggrastat tirofiban hydrochloride injection is an acutecare, hospitalbased cardiovascular pharmaceutical aggrastat is accahascai class i recommended view guidelines. Acs tirofiban protocol very high risk acute coronary syndromes addressograph. Tirofiban is cleared from the plasma largely by renal excretion. It has a role as a fibrin modulating drug, a platelet glycoproteiniibiiia receptor antagonist and an anticoagulant. Tirofiban interactions bnfc content published by nice. The reversible platelet glycoprotein iibiiia receptor inhibitor. Tirofiban is a generic medicine name and there are several brands available for it. Tirofiban is primarily eliminated through renal excretion, so dose adjustments are needed. 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. 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. Many investigators have suggested that a lower dose of tirofiban be used in patients with chronic renal insufficiency cri to decrease adverse outcomes, the. Five patients in this analysis had endstage renal disease requiring hemodialysis. 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.
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. Tirofiban is removed by hemodialysis and can be used with caution in these patients. Feb 18, 2019 provides accurate and independent information on more than 24,000 prescription drugs, overthecounter medicines and natural products. Reduce the dose in patients with severe renal insufficiency. The information on dosage adjustments in renal impairment given in this book is. Aggrastat 50 mcgml solution for infusion summary of. Tirofiban is used to prevent blood clots or heart attack in people with severe chest pain or other conditions, and in those who are undergoing a procedure called angioplasty to open blocked arteries. Aggrastat tirofiban dosing, indications, interactions.
Dosage adjustment of medications eliminated by the kidneys. Tirofiban hydrochloride monohydrate is a white to offwhite, nonhygroscopic, freeflowing powder, with a molecular weight of 495. Tirofiban 732 tizanidine 733 tobramycin 734 tolbutamide 735 tolfenamic acid 736. 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. If crcl webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Find patient medical information for tirofiban in 0. Aggrenox aspirinextendedrelease dipyridamole capsules. Following usual bolus dose, initiate constant infusion at 0.
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. Jan 30, 2018 renal and biliary excretion contribute significantly to the elimination of tirofiban. Aggrastat tirofiban hydrochloride injection premixed 9123301 aggrastat tirofiban hydrochloride injection 2 concentration during the infusion. 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.
115 1152 404 314 332 226 533 840 712 1150 111 1197 250 292 345 201 8 1212 1156 16 77 1396 589 839 1469 670 629 1234 761 147 381 1058 1322 228 433