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

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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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