Alternate Name(s):
Integrilin
Classification:
Antiplatelet Agent, Glycoprotein IIb/IIIa Inhibitor
Original Date:
June 2024
Indications:
- US/NSTEMI including those who may subsequently undergo to PCI (Adults)
- Eptifibatide Injection is indicated for the treatment of patients undergoing PCI including those undergoing intracoronary stenting. (Adults)
- Eptifibatide Injection is intended for use with ASA and heparin. (Adults)
- Limited Data in Pediatrics
- Data for Adults in Neuro Thrombectomy/Stroke, Neuro Aneurism Treatment
Reconstitution and Stability:
- Available as a 0.75 mg/mL 100mL vial and 2mg/mL 10mL vial
- Store unopened vials in refrigerator. Vials stable at room temperature for up to 2 months.
- Protect from Light until administration but does not require protection during administration
Compatibility:
Y-site: D5NS, 0.9% NaCl, alteplase, atropine, dobutamine, heparin, lidocaine, meperidine, metoprolol, midazolam, morphine, nitroglycerin, or verapamil
Incompatible: furosemide
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV direct |
YES (by interventional radiologist only. IV or intra-arterial - use 2mg/mL |
| IV intermittent infusion | NO |
| IV continuous infusion |
YES (Neuro interventional radiology lab and PICU only) 0.75mg/mL vial is spiked with a vented infusion set and administered via infusion pump |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- Bolus: 180 mcg/kg IV or intra-arterial push (max 22.6mg)
- Maintenance infusion: 2 mcg/kg/min (Max 15mg/hr) (normal renal function)
- Dose adjustment maybe required for reduced renal function
- Contraindicated in patients with ESRD or Dialysis dependent
Potential hazards of parenteral administration:
Warning:
- Risk of major and minor bleeding may increase in patients <70kg
- An immune-mediated thrombocytopenia similar to heparin-induced thrombocytopenia
Monitoring:
- Monitor for mental status changes and signs of excessive bleeding (CNS changes; blood in urine, stool, or vomitus; unusual bruising, or bleeding.
Laboratory tests at baseline and during therapy:
- CBC (recommended at 2-4 hours after initiation, and at 24 hours or prior to discharge, whichever is first.
- Serum creatinine, INR, PT/aPTT
Notes:
Contraindications:
- Hypersensitivity to eptifibatide or any component of the formulation
- Active abnormal bleeding within the previous 30 days or a history of bleeding diathesis
- History of stroke within 30 days or a history of hemorrhagic stroke
- Severe hypertension (systolic blood pressure >200 mm Hg or diastolic blood pressure >110 mm Hg) not adequately controlled on antihypertensive therapy
- major surgery within the preceding 6 weeks;
- Current or planned administration of another parenteral GP IIb/IIIa inhibitor
- PT >1.2 times control or INR ≥2.0
- Known history of intracranial disease (eg, neoplasm, arteriovenous malformation, aneurysm)
- Severe renal impairment or on hemodialysis
- Thrombocytopenia (<100,000 cells/mm3)
- Clinically significant liver disease
References:
- Lexicomp Online - eptifibatide
- Brinjikji W et al. Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms. Stroke. 2013 May;44(5):1343-7.
- Sedat J et al. Administration of eptifibatide during endovascular treatment of ruptured cerebral aneurysms reduces the rate of thromboembolic events. Neuroradiology. 2015 Feb;57(2):197-203
- Yi HJ et al. Initial experience with the use of intravenous eptifibatide bolus during endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol. 2006 Oct;27(9):1856-60.
- Ramakrishnan P, et al. Intra-Arterial Eptifibatide in the Management of Thromboembolism during Endovascular Treatment of Intracranial Aneurysms: Case Series and a Review of the Literature. Interv Neurol. 2013 Oct;2(1):19-29.
- Dumont TM et al. Adjunctive use of eptifibatide for complication management during elective neuroendovascular procedures. J Neurointerv Surg. 2013 May;5(3):226-30.
- Katsaridis V et al. Local intra-arterial eptifibatide for intraoperative vessel thrombosis during aneurysm coiling. AJNR Am J Neuroradiol. 2008 Aug;29(7):1414-7.
- Mack EH, Wheeler DS, Hirsch R. Endovascular treatment of near-fatal neonatal superior vena cava syndrome. Pediatr Crit Care Med. 2011 Nov;12(6)
- Epelman S et al. Eptifibatide-induced thrombocytopenia and thrombosis. J Thromb Thrombolysis. 2006 Oct;22(2):151-4.
- Simonato, D., Borchert, R. J., Labeyrie, M.-A., Fuschi, M., Thibault, L., Henkes, H., Fiorella, D., Tan, B. Y. Q., Yeo, L. L., Makalanda, H. L. D., Wong, K., & Bhogal, P. (Year). Glycoprotein IIb/IIIa inhibitors for the neurointerventionalist. Interventional Neuroradiology 28(1), Pages 84-91.