Tirofiban

CLINICAL USE

Antiplatelet agent: Prevention of early myocardial infarction in patients with unstable angina or non-ST segment elevation myocardial infarction, and with last episode of chest pain within 12 hours

DOSE IN NORMAL RENAL FUNCTION

Initially 0.4 mcg/kg/minute for 30 minutes then 0.1 mcg/kg/minute for at least 48 hours

PHARMACOKINETICS

Molecular weight : 495.1

%Protein binding : 65

%Excreted unchanged in urine : 66

Volume of distribution (L/kg) : 22–42 litres

half-life – normal/ESRD (hrs) : 1.5–2/increased

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–50 Dose as in normal renal function 10–30 Give 50% of dose

<10 : Give 50% of dose

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

HD : Dialysed. Dose as in GFR <10 mL/min

HDF/high flux : Dialysed. Dose as in GFR <10 mL/min

CAV/VVHD : Unknown dialysability. Dose as in GFR=10–30 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs Iloprost: increased risk of bleeding

Heparin: increased risk of bleeding

ADMINISTRATION

Reconstition

–

Route

IV infusion

Rate of Administration

0.1–0.4 mcg/kg/minute

Comments

Add 50 mL of the concentrate (250 mcg/ mL) to 250 mL sodium chloride 0.9% or glucose 5%, to give a final concentration of 50 mcg/mL (remove 50 mL from bag first)

OTHER INFORMATION

Antiplatelet effect lasts for about 4–8 hours after stopping infusion Main side effect is bleeding Increased risk of bleeding once renal function falls to a GFR<60 mL/min – monitor carefully .

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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