Tirofiban hydrochloride
Tirofiban hydrochloride (Aggrastat)
Tirofiban hydrochloride
( ty-roh- FYE-ban)
Pregnancy Category: B Aggrastat (Rx)

Classification: Antiplatelet drug

Action/Kinetics: Non-peptide antagonist of the platelet glycoprotein (GP) IIb/IIIa receptor, which is the major platelet surface receptor involved in platelet aggregation. Activation of the receptor leads to binding of fibrinogen and von Willebrand's factor to platelets, and thus aggregation. Tirofiban is a reversible antagonist of fibrinogen binding to the GP IIb/IIIa receptor, thus inhibiting platelet aggregation. t 1/2: About 2 hr. Cleared from the plasma mainly unchanged by renal excretion (65%) and feces (25%). Plasma clearance is lower in clients over 65 years of age and is significantly decreased in those with a C _CR less than 30 mL/min.

Uses: In combination with heparin for acute coronary syndrome (ACS), including those being treated medically and those undergoing PTCA or atherectomy.

Contraindications: Active internal bleeding or history of diathesis within the previous 30 days; history of intracranial hemorrhage, intracranial neoplasm, AV malformation, or aneurysm; history of thrombocytopenia following prior use of tirofiban; history of stroke within 30 days or any history of hemorrhagic stroke; major surgical procedure or severe physical trauma within the last month; history, findings, or symptoms suggestive of aortic dissection; severe hypertension (systolic BP greater than 180 mm Hg or diastolic BP greater than 110 mm Hg); concomitant use of another parenteral GP IIb/IIIa inhibitor; acute pericarditis.

Special Concerns: Use with caution in clients with a platelet count less than 150,000/mm ³ in hemorrhagic retinopathy, with other drugs that affect hemostasis (e.g., warfarin). Safety and efficacy in children less than 18 years of age have not been established. Safety when used in combination with thrombolytic drugs has not been determined.

Side Effects: Most common is bleeding, including intracranial bleeding, retroperitoneal bleeding, major GI and GU bleeding. Female and elderly clients have a higher incidence of bleeding than male or younger clients. Miscellaneous: Nausea, fever, headache, bradycardia, coronary artery dissection, dizziness, edema or swelling, leg pain, pelvic pain, vasovagal reaction, sweating.

Laboratory Test Alterations: H&H;, platelets. Urine and fecal occult blood.

Overdose Management: Symptoms: Bleeding, including minor mucocutaneous bleeding events and minor bleeding at the site of cardiac catheterization. Treatment: Assess clinical condition. Adjust or cease infusion, as appropriate. Can be removed by hemodialysis.

Drug Interactions: Aspirin / Bleeding Evening primrose oil / Potential for antiplatelet effect Feverfew / Potential for antiplatelet effect Garlic / Potential for antiplatelet effect Ginger / Potential for antiplatelet effect Ginkgo biloba / Potential for antiplatelet effect Ginseng / Potential for antiplatelet effect Grapeseed extract / Potential for antiplatelet effect Heparin / Bleeding Levothyroxine / Tirofiban clearance Omeprazole / Tirofiban clearance

How Supplied: Injection: 50 mcg/mL; Injection For Solution: 250 mcg/mL

Dosage
?IV Acute coronary syndrome.
Initial: 0.4 mcg/kg/min for 30 min; then 0.1 mg/kg/min. Use half the usual rate in those with severe renal impairment. Consult package insert for the guide to dosage adjustment by weight of the client.