TIROFIBAN HYDROCHLORIDE
(tir-o-fi'ban)
Aggrastat
Classifications: blood formers, coagulators, and anticoagulants; antiplatelet agent; glycoprotein iib/iiia receptor inhibitor
Prototype: Abciximab
Pregnancy Category: B

Availability

250 mcg/mL, 50 mcg/mL injection

Actions

Antiplatelet agent that binds to the glycoprotein IIb/IIIa receptor of platelets.

Therapeutic Effects

Inhibits platelet aggregation. Effectiveness indicated by minimizing thrombotic events during treatment of acute coronary syndrome.

Uses

Acute coronary syndromes (unstable angina, MI).

Contraindications

Active internal bleeding within 30 d; acute pericarditis; aortic dissection; concurrent use with another glycoprotein IIb/IIIa receptor inhibitor (e.g., eptifibatide, abciximab); history of aneurysm or AV malformation; history of intracranial hemorrhage or neoplasm; hypersensitivity to tirofiban; major surgery or trauma within 3 d; stroke within 30 d; history of hemorrhagic stroke; thrombocytopenia following administration of tirofiban; pregnancy (category B); lactation.

Cautious Use

Concomitant use with thrombolytic agents or drugs that cause hemolysis; hemorrhagic retinopathy; platelet count <150,000 mm³; severe renal insufficiency. Safety and efficacy in children <18 y are unknown.

Route & Dosage

Acute Coronary Syndromes
Adult: IV Loading Dose 0.4 mcg/kg/min times 30 min IV Maintenance Dose 0.1 mcg/kg/min for 12–24 h after angioplasty or arteriectomy

Renal Impairment
Cl_cr <30 mL/min: Reduce rate of infusion 50%

Administration

Intravenous

PREPARE: IV Infusion: Withdraw 100 mL from a 500-mL bag of NS or D5W and replace with 100 mL of tirofiban HCl injection. If a 250-mL IV bag is used, withdraw 50 mL of IV solution and replace with 50 mL of tirofiban injection. Either preparation yields 50 mcg/mL. Mix well before infusing. Note: Commercially premixed IV tirofiban solutions are available.

ADMINISTER: IV Infusion: An initial loading dose of 0.4 mcg/kg/min for 30 min is usually followed by a maintenance infusion of 0.1 mcg/kg/min.

INCOMPATIBILITIES Y-site: Diazepam.

Discard unused IV solution 24 h following start of infusion.
Store unopened containers at 15°–30° C (59°–86° F). Do not freeze and protect from light.

Adverse Effects (1%)

Body as a Whole: Edema, swelling, pelvic pain, vasovagal reaction, leg pain. CNS: Dizziness. CV: Bradycardia, coronary artery dissection. GI: GI bleeding. Hematologic: Bleeding (major bleeding), anemia, thrombocytopenia. Skin: Sweating.

Interactions

Drug: Increased risk of bleeding with anticoagulants, nsaids, salicylates, antiplatelet agents. Herbal: Feverfew, garlic, ginger, ginkgo, horse chestnut may increase risk of bleeding.

Pharmacokinetics

Duration: 4–8 h after stopping infusion. Distribution: 65% protein bound. Metabolism: Minimally metabolized. Elimination: 65% excreted in urine, 25% in feces. Half-Life: 2 h.

Nursing Implications

Assessment & Drug Effects

Lab tests: Monitor platelet count, Hgb and Hct before treatment, (within 6 h of infusing loading dose), and frequently throughout treatment; monitor aPTT, INR, and ACT.
Withhold drug and notify physician if thrombocytopenia (platelets <100,000) is confirmed.
Monitor carefully for and immediately report S&S of internal or external bleeding.
Wait at least 3–4 h after heparin is stopped and until ACT <180 sec and aPPT <45 sec before removing the femoral catheter sheath.
Minimize unnecessary invasive procedures and devices to reduce the risk of bleeding.

Patient & Family Education

Report unexplained pelvic or abdominal pain.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug