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
IV
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: