Tirofiban Side Effects
It is possible that some side effects of tirofiban may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.
For the Consumer
Applies to tirofiban: intravenous solution
As well as its needed effects, tirofiban may cause unwanted side effects that require medical attention.
If any of the following side effects occur while taking tirofiban, check with your doctor or nurse immediately:More common
- Abdominal or stomach pain or swelling
- arm, back, or jaw pain
- black, tarry stools
- blood in the eyes
- blood in the urine
- bruising or purple areas on the skin
- chest pain or discomfort
- chest tightness or heaviness
- coughing up blood
- decreased alertness
- fast or irregular heartbeat
- joint pain or swelling
- Bleeding gums
- lightheadedness or fainting
- pinpoint red spots on the skin
- severe, unusual tiredness or weakness
- slow heartbeat
- swelling of the hands, ankles, feet, or lower legs
- Chills or fever
- difficulty swallowing
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- skin rash, hives, or itching
- trouble breathing
Some tirofiban side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:More common
- Pain in the legs or hips
For Healthcare Professionals
Applies to tirofiban: intravenous powder for injection, intravenous solution
Prior to approval by the FDA the efficacy and safety of tirofiban was evaluated in 1,946 patients who received both tirofiban and heparin and 2,002 patients who received tirofiban alone. The average duration of exposure was 116 hours. Forty-three percent of the patients were greater than 65 years old and approximately 30% of the patients were female. In clinical studies, the incidences of side effects were generally similar among different races, and were not more prevalent among patients with hypertension or diabetes or hypercholesterolemia. The most common and potentially significant side effect was bleeding; non-bleeding side effects occurred in up to approximately 6% of patients. The overall incidence of non-bleeding side effects was higher in female and older patients compared with male or younger patients. However, the incidence of non-bleeding side effects was similar among all patients who received tirofiban + heparin versus heparin alone.[Ref]
Hematologic lab changes in patients who received tirofiban + heparin versus heparin alone have included decreases in hemoglobin in 2.1% and 3.1% and hematocrit in 2.2% and 2.6%, increases in microhematuria in 10.7% and 7.8%, and increases in fecal occult blood in 18.3% and 12.2% of patients, respectively.
The incidence of thrombocytopenia (less than 100,000 cells/mcL) associated with tirofiban is 1.1% to 1.9%, while severe thrombocytopenia (less than 50,000 cells/mcL) has been reported in 0.2% to 0.5% of patients in clinical trials.
Decreases in platelet concentrations have been associated with the use of heparin alone. The incidences of reversible decreases in platelet concentrations among patients treated the tirofiban + heparin versus heparin alone in controlled trials were 1.5% and 0.6% (platelet counts less than 90,000/mm3) and 0.3% and 0.1% (platelet counts less than 50,000/mm3) of patients, respectively.
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, duration of GP IIb/IIIa inhibitor infusion, baseline platelet count, 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.[Ref]
The most common and potentially serious side effect associated with the use of tirofiban (and heparin and aspirin) has been bleeding. The incidences of major and minor bleeding in the PRISM-PLUS trial were 1.4% and 10.5%, respectively, and the incidence of transfusions was 4.0%. The incidences of these events in the RESTORE trial were 2.2%, 12.0%, and 4.3%. All incidences were greater than those observed among patients who were given heparin alone. There were no reports of intracranial hemorrhage (ICH) in the PRISM-PLUS trial, but the incidences of ICH associated with the use of tirofiban + heparin and heparin alone in the RESTORE trial were 0.1% and 0.3%. For patients who received tirofiban + heparin versus heparin alone, the following incidences were observed: retroperitoneal bleeding, 0% and 0.1% (PRISM-PLUS) and 0.6% and 0.3% (RESTORE), respectively; and gastrointestinal or genitourinary bleeding, 0.1% and 0.1% (PRISM-PLUS) and 0.2% and 0.0%, respectively. The incidences of major bleeding in patients undergoing PTCA in PRISM-PLUS among patients who were given tirofiban + heparin versus heparin alone were 0.3% and 0.1% (pre-PTCA), 1.3% and 0.7% (following angiography), and 2.5% and 2.2% (following PTCA), respectively. Female and elderly patients in either group had a higher incidence of bleeding compared with male or younger patients. Concomitant use of heparin did not confer significant additional risk of bleeding in any group.[Ref]
Cardiovascular side effects in patients who received tirofiban + heparin versus heparin alone have included edema or swelling in 2% and 1%, bradycardia in 4% and 3%, and coronary artery dissection in 5% and 4% of patients, respectively. Many side effects may in fact be attributed to underlying disease or the risks of procedures patients were undergoing.
Analysis of one study (TARGET trial) indicates that patients with renal dysfunction undergoing PCI and receiving a GP IIb/IIIa inhibitor (i.e., tirofiban, abciximab) are at a higher risk of developing ischemic complications (30-day death, myocardial infarction,urgent revascularization) than patients with normal creatinine clearance.[Ref]
Musculoskeletal side effects in patients who received tirofiban + heparin versus heparin alone have included pelvic pain in 6% and 5% and general leg pain in 3% and 2% of patients, respectively. These side effects may in fact be attributed to complications associated with femoral artery access associated with angiography.[Ref]
Nervous system side effects in patients who received tirofiban + heparin versus heparin alone have included vasovagal reactions in 2% and 1%, dizziness in 3% and 2%, and sweating in 2% and 1% of patients, respectively. Headache has been associated with the use of tirofiban + heparin in approximately 1% of patients (and in a similar fraction of patients treated with heparin alone).[Ref]
The only gastrointestinal side effect noted among patients in controlled trials was nausea, observed in approximately 1% of patients.[Ref]
Hypersensitivity reactions were remarkably absent in clinical studies prior to FDA approval. There were no recorded instances of anaphylaxis or hives. There are no data regarding the development of anti-tirofiban antibodies; very few patients have received this drug twice.[Ref]
1. "Product Information. Aggrastat (tirofiban)." Merck & Co, Inc, West Point, PA.
2. Adgey AA "An overview of the results of clinical trials with glycoprotein IIb/IIIa inhibitors." Am Heart J 135 (1998): s43-55
3. The Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. "Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-q-wave myocardial infarction." N Engl J Med 338 (1998): 1488-97
4. Kirtane AJ, Piazza G, Murphy SA, et al. "Correlates of bleeding events among moderate- to high-risk patients undergoing percutaneous coronary intervention and treated with eptifibatide: observations from the PROTECT-TIMI-30 trial." J Am Coll Cardiol 47 (2006): 2374-9
5. Blankenship JC "Bleeding complications of glycoprotein IIb-IIIa receptor inhibitors." Am Heart J 138 (1999): s287-96
6. Skubas NJ, Despotis GJ, Vlasnic JJ, Moon MR "Preoperative use of enoxaparin and tirofiban: Possible association with increased bleeding postbypass." Anesthesiology 91 (1999): 869-72
7. Brouse SD, Wiesehan VG "Evaluation of bleeding complications associated with glycoprotein IIb/IIIa inhibitors." Ann Pharmacother 38 (2004): 1783-8
8. The RESTORE Investigators "Effects of platelet glycoprotein IIb/IIIa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction..." Circulation 96 (1997): 1445-53
9. Berger PB, Best PJ, Topol EJ, et al. "The relation of renal function to ischemic and bleeding outcomes with 2 different glycoprotein IIb/IIIa inhibitors: the do Tirofiban and ReoPro Give Similar Efficacy Outcome (TARGET) trial." Am Heart J 149 (2005): 869-75
10. Huxtable LM, Tafreshi MJ, Rakkar AN "Frequency and Management of Thrombocytopenia With the Glycoprotein IIb/IIIa Receptor Antagonists." Am J Cardiol 97 (2006): 426-9
11. Alexander KP, Chen AY, Newby LK, et al. "Sex Differences in Major Bleeding With Glycoprotein IIb/IIIa Inhibitors. Results From the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Initiative." Circulation 114 (2006): 1380-7
12. The Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) Study Investigators "A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina." N Engl J Med 338 (1998): 1498-505
More about tirofiban
- Other brands: Aggrastat
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