Tirofiban Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Acute Coronary Syndrome

Initial (IV): 25 mcg/kg over 3 minutes

Maintenance (IV): 0.15 mcg/kg/min constant infusion for up to 18 hours

Indication: To reduce the rate of thrombotic cardiovascular events in patients with non-ST elevation acute coronary syndrome (NSTE-ACS).

Renal Dose Adjustments

CrCl 60 mL/min or less: Following usual bolus dose, initiate constant infusion at 0.075 mcg/kg/min.

Liver Dose Adjustments

Data not available

Precautions

Tirofiban is contraindicated in patients with active internal bleeding or a history of bleeding diathesis within the previous 30 days; a history of intracranial hemorrhage, intracranial neoplasm, arteriovenous malformation, or aneurysm; a history of thrombocytopenia following prior exposure to tirofiban; history of stroke within 30 days or any history of hemorrhagic stroke; major surgical procedure or severe physical trauma within the previous month; history, symptoms, or findings suggestive of aortic dissection; severe hypertension (systolic blood pressure greater than 180 mm Hg and/or diastolic blood pressure greater than 110 mm Hg); concomitant use of another parenteral glycoprotein IIb/IIIa inhibitor; or acute pericarditis.

Tirofiban should be used with caution in patients with platelet counts less than 150,000/mm3 and in patients with hemorrhagic retinopathy. If bleeding occurs during therapy and the bleeding cannot be controlled by pressure, it is recommended that tirofiban (and heparin, if applicable), should be discontinued immediately.

Risk factors for bleeding events in patients treated with glycoprotein (GP) IIb/IIIa inhibitors undergoing percutaneous coronary intervention have been identified and include advanced age, renal dysfunction, female gender, peripheral vascular disease, lower body weight, lower baseline hemoglobin, diabetes, and elevated peak activated clotting time. According to one study (CRUSADE trial) involving patients with non ST segment elevation acute coronary syndrome treated with a GP IIb/IIIa inhibitor, women are at a greater risk of bleeding than men, primarily because of excessive dosing.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

The final concentration of tirofiban for infusion should be 50 mcg/mL.

In clinical trials of tirofiban, aspirin and heparin were usually administered concomitantly.

It is recommended that platelet counts, and hemoglobin and hematocrit be monitored prior to treatment, within 6 hours following the loading infusion, and at least daily during therapy. If there are significant changes in these lab values, more frequent monitoring is recommended. Confirmed thrombocytopenia (less than 90,000/mm3) is an indication to withhold or discontinue tirofiban (and heparin, if applicable).

To monitor unfractionated heparin, aPTT should be monitored 6 hours after the start of heparin infusion, and heparin should be adjusted to maintain aPTT at approximately 2 times control values.

A posthoc analysis of the PRISM PLUS trial involving patients with unstable angina/non ST elevation myocardial infarction revealed that use of tirofiban, in addition to heparin, provides a greater benefit and is associated with a lower risk of bleeding complications in men than in women at 30 and 180 days.

The results of one study indicate that in patients with acute myocardial infarction undergoing artery stenting, early vs late administration (18 min vs 52 min after admission, respectively) of tirofiban was associated with a significant reduction in infarct size and improvement in myocardial salvage index. The 30 day composite end point of death, recurrent MI, or rehospitalization also favored early administration of tirofiban.

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