Abciximab

CLINICAL USE

Antiplatelet agent:

  • Prevention of ischaemic cardiac
  • complications in patients undergoing percutaneous coronary intervention
  • Short-term prevention of myocardial infarction in patients with unstable angina not responding to treatment or awaiting percutaneous coronary intervention

    DOSE IN NORMAL RENAL FUNCTION

    IV bolus: 250 mcg/kg then by infusion at 0.125 mcg/kg/minute for 12 hours after intervention (maximum 10 mcg/minute)

    PHARMACOKINETICS

  • Molecular weight                           :47 455.4
  • %Protein binding                           :Binds to platelets
  • %Excreted unchanged in urine     : Minimal (catabolised like other proteins)
  • Volume of distribution (L/kg)       :0.1181
  • half-life – normal/ESRD (hrs)      :<10 minutes/unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Dose as in normal renal function. Use with caution

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unlikely to be dialysed. Dose as in GFR <10 mL/min
  • HD                     :Unlikely to be dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux   :Unlikely to be dialysed. Dose as in GFR <10 mL/min
  • CAV/VVHD      :Unlikely to be dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsHeparin, anticoagulants, antiplatelets and thrombolytics: increased risk of bleeding

    ADMINISTRATION

    Reconstition

    Route

    IV bolus,

    IV infusion

    Rate of Administration

    Bolus: 1 minute Infusion: 0.125 mcg/kg/minute (maximum 10 mcg/minute)

    Comments

    Dilute in sodium chloride 0.9% or glucose 5%Give via a non-pyrogenic low-protein- binding 0.2, 0.22 or 5 micron filter

    OTHER INFORMATION

  • Increased risk of bleeding in CKD 5, benefits of abciximab treatment may be reduced
  • In the UK the licence says avoid in haemodialysis patients due to increased risk of bleeding (as on heparin for dialysis) but it is used in normal doses in the USA
  • Antibodies to abciximab develop 2–4 weeks post dose in 5.8% of patients so monitor for hypersensitivity reactions if re-administered
  • Abciximab remains in the body for at least 15 days, bound to platelets
  • Once infusion is stopped, the concentration of abciximab falls rapidly for 6 hours then decreases at a slower rate
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