Generic drug: eptifibatide
Brand name: Integrilin
What is Integrilin (eptifibatide), and how does it work?
Integrilin (eptifibatide) injection is a platelet aggregation inhibitor indicated for treatment of acute coronary syndrome (ACS) managed medically or with percutaneous coronary intervention (PCI), and treatment of patients undergoing PCI (including intracoronary stenting). Integrilin injection is available in generic form.
What are the side effects of Integrilin?
Common side effects of Integrilin injection include:
- bleeding
- low blood pressure
Tell your doctor if you have serious side effects of Integrilin injection including:
- easy bruising,
- unusual bleeding (nose, mouth, vagina, or rectum),
- purple or red pinpoint spots under your skin
- blood in your urine
- black, bloody, or tarry stools
- coughing up blood or vomit that looks like coffee grounds
- any bleeding that will not stop
- sudden numbness or weakness, especially on one side of the body
- sudden severe headache, confusion, problems with vision, speech, or balance
- fever, chills, body aches, flu symptoms, or
- feeling like you might pass out.
What is the dosage for Integrilin?
Before infusion of Integrilin, the following laboratory tests should be performed to identify pre-existing hemostatic abnormalities: hematocrit or hemoglobin, platelet count, serum creatinine, and PT/aPTT. In patients undergoing PCI, the activated clotting time (ACT) should also be measured.
The activated partial thromboplastin time (aPTT) should be maintained between 50 and 70 seconds unless PCI is to be performed. In patients treated with heparin, bleeding can be minimized by close monitoring of the aPTT and ACT.
Dosage In Acute Coronary Syndrome (ACS)
Indication
Normal Renal Function
Creatinine Clearance less than 50 mL/min
Patients with ACS
180 mcg/kg intravenous (IV) bolus as soon as possible after diagnosis, followed by continuous infusion of 2 mcg/kg/min
180 mcg/kg IV bolus as soon as possible after diagnosis, followed by continuous infusion of 1 mcg/kg/min
- Infusion should continue until hospital discharge or initiation of coronary artery bypass graft surgery (CABG), up to 72 hours
- If a patient is to undergo PCI, the infusion should be continued until hospital discharge or for up to 18 to 24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy
- Aspirin, 160 to 325 mg, should be given daily
Integrilin should be given concomitantly with heparin dosed to achieve the following parameters:
During Medical Management
Target aPTT 50 to 70 seconds
- If weight greater than or equal to 70 kg, 5000-unit bolus followed by infusion of 1000 units/h.
- If weight less than 70 kg, 60-units/kg bolus followed by infusion of 12 units/kg/h.
During PCI
Target ACT 200 to 300 seconds
- If heparin is initiated prior to PCI, additional boluses during PCI to maintain an ACT target of 200 to 300 seconds.
- Heparin infusion after the PCI is discouraged.
Dosage In Percutaneous Coronary Intervention (PCI)
Indication
Normal Renal Function
Creatinine Clearance less than 50 mL/min
Patients with PCI
180 mcg/kg IV bolus immediately before PCI followed by continuous infusion of 2 mcg/kg/min and a second bolus of 180 mcg/kg (given 10 minutes after the first bolus)
180 mcg/kg IV bolus immediately before PCI followed by continuous infusion of 1 mcg/kg/min and a second bolus of 180 mcg/kg (given 10 minutes after the first bolus)
- Infusion should be continued until hospital discharge, or for up to 18 to 24 hours, whichever comes first. A minimum of 12 hours of infusion is recommended.
- In patients who undergo CABG surgery, Integrilin infusion should be discontinued prior to surgery.
- Aspirin, 160 to 325 mg, should be given 1 to 24 hours prior to PCI and daily thereafter.
- Integrilin should be given concomitantly with heparin to achieve a target ACT of 200 to 300 seconds. Administer 60-units/kg bolus initially in patients not treated with heparin within 6 hours prior to PCI.
- Additional boluses during PCI to maintain ACT within target.
- Heparin infusion after the PCI is strongly discouraged.
Patients requiring thrombolytic therapy should discontinue Integrilin.
Important Administration Instructions
- Inspect Integrilin for particulate matter and discoloration prior to administration, whenever solution and container permit.
- May administer Integrilin in the same intravenous line as alteplase, atropine, dobutamine, heparin, lidocaine, meperidine, metoprolol, midazolam, morphine, nitroglycerin, or verapamil. Do not administer Integrilin through the same intravenous line as furosemide.
- May administer Integrilin in the same IV line with 0.9% NaCl or 0.9% NaCl/5% dextrose. With either vehicle, the infusion may also contain up to 60 mEq/L of potassium chloride.
- Withdraw the bolus dose(s) of Integrilin from the 10-mL vial into a syringe. Administer the bolus dose(s) by IV push.
- Immediately following the bolus dose administration, initiate a continuous infusion of Integrilin. When using an intravenous infusion pump, administer Integrilin undiluted directly from the 100-mL vial. Spike the 100mL vial with a vented infusion set. Center the spike within the circle on the stopper top.
- Discard any unused portion left in the vial.
Administer Integrilin by volume according to patient weight (see Table 1).
Table 1: Integrilin Dosing Charts by Weight
Patient Weight
180-mcg/kgBolus Volume
2-mcg/kg/minInfusion Volume
(CrCl greater than or equal to 50 mL/min)
1-mcg/kg/minInfusion Volume
(CrCl less than 50 mL/min)
(kg)
(lb)
(from2-mg/mL vial)
(from 2-mg/mL100-mL vial)
(from 0.75-mg/mL100-mL vial)
(from 2-mg/mL100-mL vial)
(from 0.75-mg/mL100-mL vial)
37-41
81-91
3.4 mL
2 mL/h
6 mL/h
1 mL/h
3 mL/h
42-46
92-102
4 mL
2.5 mL/h
7 mL/h
1.3 mL/h
3.5 mL/h
47-53
103-117
4.5 mL
3 mL/h
8 mL/h
1.5 mL/h
4 mL/h
54-59
118-130
5 mL
3.5 mL/h
9 mL/h
1.8 mL/h
4.5 mL/h
60-65
131-143
5.6 mL
3.8 mL/h
10 mL/h
1.9 mL/h
5 mL/h
66-71
144-157
6.2 mL
4 mL/h
11 mL/h
2 mL/h
5.5 mL/h
72-78
158-172
6.8 mL
4.5 mL/h
12 mL/h
2.3 mL/h
6 mL/h
79-84
173-185
7.3 mL
5 mL/h
13 mL/h
2.5 mL/h
6.5 mL/h
85-90
186-198
7.9 mL
5.3 mL/h
14 mL/h
2.7 mL/h
7 mL/h
91-96
199-212
8.5 mL
5.6 mL/h
15 mL/h
2.8 mL/h
7.5 mL/h
97-103
213-227
9 mL
6 mL/h
16 mL/h
3.0 mL/h
8 mL/h
104-109
228-240
9.5 mL
6.4 mL/h
17 mL/h
3.2 mL/h
8.5 mL/h
110-115
241-253
10.2 mL
6.8 mL/h
18 mL/h
3.4 mL/h
9 mL/h
116-121
254-267
10.7 mL
7 mL/h
19 mL/h
3.5 mL/h
9.5 mL/h
>121
>267
11.3 mL
7.5 mL/h
20 mL/h
3.7 mL/h
10 mL/h
What drugs interact with Integrilin?
Use Of Thrombolytics, Anticoagulants, And Other Antiplatelet Agents
- Coadministration of antiplatelet agents, thrombolytics, heparin, aspirin, and chronic NSAID use increases the risk of bleeding.
- Concomitant treatment with other inhibitors of platelet receptor GP IIb/IIIa should be avoided.
Is Integrilin safe to use while pregnant or breastfeeding?
- Available data on eptifibatide use in pregnant women from published literature and the pharmacovigilance database are insufficient to establish a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes.
- Untreated myocardial infarction can be fatal to the pregnant woman and fetus.
- There are no available data on the presence of eptifibatide in human milk, the effects on the breastfed infant, or the effects on milk production.
- As eptifibatide is a peptide, it is likely to be destroyed in the infant’s gastrointestinal tract and not absorbed orally by the breastfed infant.