mes first, allowing for up to 96 hours of therapy.
Non-Dialysis Dependent 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 mcg/kg as soon as possible following diagnosis, immediately followed by a continuous infusion of 1.0 mcg/kg/min.
Percutaneous Coronary Intervention (PCI)
The recommended adult dosage of eptifibatide in patients with normal renal function is an intravenous bolus of 180 mcg/kg administered immediately before the initiation of PCI followed by a continuous infusion of 2.0 mcg/kg/min and a second 180-mcg/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.
Non-Dialysis Dependent 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 mcg/kg administered immediately before the initiation of the procedure, immediately followed by a continuous infusion of 1.0 mcg/kg/min and a second 180-mcg/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.
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1
Use the Cockcroft-Gault equation with actual body weight to calculate creatinine clearance:Males: (140 – age) × (actual body wt in kg) Females: (140 – age) × (actual body wt in kg) × 0.85
72 × (serum creatinine) 72 × (serum creatinine)
Aspirin and Heparin Dosing Recommendations
In the clinical trials that showed eptifibatide to be effective, most patients received concomitant aspirin and heparin. The recommended aspirin and heparin doses to be used are as follows:
Acute Coronary Syndrome
Aspirin
160 to 325 mg orally initially and daily thereafter
Heparin
Target aPTT 50 to 70 seconds during medical management
If weight ≥70 kg, 5000-U bolus followed by infusion of 1000 U/hr.
If weight <70 kg, 60-U/kg bolus followed by infusion of 12 U/kg/hr.
Target ACT 200 to 300 seconds during PCI
If heparin is initiated prior to PCI, additional boluses during PCI to maintain an ACT target of 200 to 300 seconds.
Heparin infusion after the PCI is discouraged.
PCI
Aspirin
160 to 325 mg orally 1 to 24 hours prior to PCI and daily thereafter
Heparin
Target ACT 200 to 300 seconds
60-U/kg bolus initially in patients not treated with heparin within 6 hours prior to PCI.
Additional boluses during PCI to maintain ACT within target.
Heparin infusion after the PCI is strongly discouraged.
Patients requiring thrombolytic therapy should have eptifibatide infusions stopped.
Instructions for Administration
Like other parenteral drug products, INTEGRILIN solutions should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
INTEGRILIN may be administered in the same intravenous line as alteplase, atropine, dobutamine, heparin, lidocaine, meperidi |
