Bivalirudin

CLINICAL USE

Anticoagulant:

Percutaneous coronary intervention

DOSE IN NORMAL RENAL FUNCTION

Initially bolus of 750 mcg/kg then an infusion of 1.75 mg/kg/hour

PHARMACOKINETICS

Molecular weight :2180.3

%Protein binding :0

%Excreted unchanged in urine : 20

Volume of distribution (L/kg) :0.1

half-life – normal/ESRD (hrs) :13–37 minutes/ 57 minutes (310 minutes in dialysis patients on non-

HD days)

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–50 Dose as in normal renal function10–30 Normal bolus dose. Reduce infusion dose by 20% (1.4 mg/kg/hour). See ‘Other Information’

<10 : Normal bolus dose. Reduce infusion dose by 80% and monitor ACT. See ‘Other Information’

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as for GFR <10 mL/min

HD :Dialysed. Dose as for GFR

<10 : mL/min

HDF/high flux :Dialysed. Dose as for GFR

<10 : mL/min

CAV/VVHD :Unknown dialysability. Dose as for GFR=10–29 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Antiplatelets and anticoagulants: increased risk of bleeding

Thrombolytics: may increase risk of bleeding complications; enhance effect of bivalirudin

ADMINISTRATION

Reconstition

Reconstitute each 250 mg vial with 5 mL water for injection

Route

Rate of Administration

1.75 mg/kg/hour

Comments

Further dilute with 50 mL sodium chloride 0.9% or glucose 5% if for infusion

Stable for 24 hours at room temperature

OTHER INFORMATION

Monitor ACT in renal impairment

Can start bivalirudin 30 minutes after stopping unfractionated heparin and 8 hours after stopping LMWHNo known antidote Dose recommendations vary from country to country; doses above are from New Zealand

UK doses: GFR=30–59 mL/min: reduce dose by —20%GFR<30 mL/min: contraindicated —USA doses: Normal dose: 1 mg/kg bolus then —2.5 mg/kg infusionGFR=30–59 mL/min: reduce dose by —20%GFR=10–29 mL/min: reduce dose by —60%Dialysis dependent: reduce dose by —90%

Lobo BL. Use of newer anticoagulants in patients with chronic kidney disease. Am J Health-Syst Pharm. 2007, Oct 1; 64: 2017–26:

GFR=30–50 mL/min: 1.75 mg/kg/hour —

GFR<30 mL/min: 1 mg/kg/hour —

On haemodialysis: 0.25 mg/kg/hour

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