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Eptifibatide (INTEGRILIN) - renal dosing

Usual Dosing (Adults)

Percutaneous Coronary Intervention (PCI): 180 µg/kg IV bolus 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 weighing more than 121 kg should receive a maximum of 22.6 mg per bolus followed by a maximum infusion rate of 15 mg per hour.

Acute Coronary Syndrome: IV 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 18-24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy. Patients weighing more than 121 kg should receive a maximum bolus of 22.6 mg followed by a maximum infusion of 15 mg per hour.


DOSAGE AND ADMINISTRATION
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.

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 Less Than 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.

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 Less Than 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.

1. Use the Cockcroft-Gault equation with actual body weight to calculate creatinine clearance:

Men: Creatinine clearance (mL/min) = Weight (kg) x (140 – age) /
      [72 x serum creatinine (mg/dL)]
Women: 0.85 x the value calculated for men.

Renal Dosing

dialysis [CRCL >50 ml/min]:   
No Changes


[CRCL <50 ml/min]:

1) Percutaneous Coronary Intervention (PCI)
Dosing adjustment in renal impairment:  
Patients with CRCL less  than 50 mL/min:  The recommended adult dose of eptifibatide in patients with an estimated CRCL < 50 ml/min (using the Cockcroft-Gault equation) is an IV bolus of 180 µg/kg (maximum: 22.6 mg) administered immediately before the initiation of the procedure, immediately followed by a continuous infusion of 1.0 µg/kg/min (maximum: 7.5 mg/hour) and a second 180 µg/kg bolus (maximum: 22.6 mg)  administered 10 minutes after the first.  In patients who undergo coronary artery bypass graft surgery, eptifibatide infusion should be discontinued prior to surgery.


2) Acute Coronary Syndrome: 
Dosing adjustment in renal impairment:  Patients with CRCL less than 50 ml/min:  The recommended adult dosage of eptifibatide in patients with acute coronary syndrome with an estimated CRCL <50 ml/min (using the Cockcroft-Gault equation)  is an IV bolus of 180 µg/kg (maximum: 22.6 mg) as soon as possible following diagnosis, immediately followed by a continuous infusion of 1.0 µg/kg/min (maximum: 7.5 mg/hour).
 

Hemodialysis

dialysis The use of eptifibatide is contraindicated in patients on dialysis.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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