Tirofiban

Indications

Tirofiban is used for: Acute coronary syndrome

Adult Dose

Intravenous Acute coronary syndrome Adult: In combination w/ unfractioned heparin and oral antiplatelet therapy, including aspirin: Patients w/ ST-elevation MI (STEMI) undergoing primary PCI or patients w/ non-ST-elevation MI (NSTEMI) undergoing PCI w/in 4 hr of diagnosis: Initially, 25 mcg/kg bolus over 3 min followed by a continuous infusion of 0.15 mcg/kg/min for 12-24 hr. Max duration: 48 hr. Patients w/ NSTEMI undergoing PCI >4 hr after diagnosis: Initially, 0.4 mcg/kg/min for 30 min followed by 0.1 mcg/kg/min, started at the time of diagnosis and continued for at least 48 hr. Infusion may be continued during coronary angiography and maintained for 12-24 hr after angioplasty or atherectomy. Max duration: 108 hr. Hepatic impairment: Severe: Contraindicated.

Child Dose

Renal Dose

Renal impairment: CrCl (ml/min) Dosage Recommendation <30 Reduce dose by 50%.

Administration

Contra Indications

History of thrombocytopenia during earlier use of GP IIb/IIIa receptor antagonist; history of stroke w/in 30 days or history of haemorrhagic stroke; history of intracranial disease (e.g. neoplasm, aneurysm); active or recent (w/in 30 days) clinically relevant bleeding (e.g. GI bleeding); malignant HTN; relevant trauma or major surgery (w/in the past 6 wk); thrombocytopenia (platelet count <100,000/mm3), disorders of platelet function; clotting disturbances. Severe hepatic failure.

Precautions

Patient w/ anaemia, active peptic ulcer (w/in the past 3 mth), uncontrolled HTN, acute pericarditis, active or history of vasculitis, suspected aortic dissection, haemorrhagic retinopathy, occult blood in stool or haematuria, thrombocytopenia (platelet count <150,000/mm3) or known history of platelet function disturbance, recent bleeding (<1 yr), severe CHF, cardiogenic shock. Severe trauma or surgery (>6 wk but <3 mth previously); traumatic or protracted CPR, organ biopsy or lithotripsy (w/in the past 2 wk), puncture of a non-compressible vessel (w/in 24 hr), recent epidural procedure. Renal and mild to moderate hepatic impairment. Pregnancy and lactation. Monitoring Parameters Monitor signs of bleeding, platelet counts, activated thromboplastin time (aPTT), haematocrit and Hb before and periodically (e.g. w/in the first 6 hr of the loading infusion and daily thereafter).

Pregnancy-Lactation

Interactions

Adverse Effects

Side effects of Tirofiban : Nausea, headache, fever, rashes and other hypersensitivity reactions, thrombocytopenia, anaemia, minor bleeding (e.g. mild mucocutaneous bleeding). Potentially Fatal: Major bleeding (e.g. intracranial or retroperitoneal haemorrhage).

Mechanism of Action

Tirofiban is a non-peptide tyrosine derivative that prevents fibrinogen binding to the glycoprotein (GP) IIb/IIIa receptor, leading to inhibition of platelet function, evidenced by its ability to inhibit ex vivo ADP-induced platelet aggregation and prolong bleeding time.