Adults: Acute Coronary Syndrome. In patients with normal kidney function: the recommended adult dosage of Eptifibatide is an IV bolus of 180 μg/kg given as soon as possible after diagnosis, followed by a continuous infusion of 2 μg/kg/min until hospital discharge or the start of CABG surgery, for up to 72 hours. If the patient goes on to have a PCI while receiving Eptifibatide, the infusion should be continued up to hospital discharge, or for 18 to 24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy in total. In patients with creatinine clearance below 50 ml/min: the recommended adult dosage of Eptifibatide is an IV bolus of 180 μg/kg given as soon as possible after diagnosis, immediately followed by a continuous infusion of 1 μg/kg/min.
Percutaneous Coronary Intervention (PCI). In patients with normal kidney function: the recommended adult dosage of Eptifibatide is an IV bolus of 180 μg/kg given immediately before the PCI begins, followed by a continuous infusion of 2 μg/kg/min and a second 180 μg/kg bolus given 10 minutes after the first. The infusion should be continued until hospital discharge, or for up to 18 to 24 hours, whichever comes first, with a minimum of 12 hours of infusion recommended. In patients with creatinine clearance below 50 ml/min: the recommended adult dose of Eptifibatide is an IV bolus of 180 μg/kg given immediately before the procedure begins, immediately followed by a continuous infusion of 1 μg/kg/min and a second 180 μg/kg bolus given 10 minutes after the first. In patients who go on to have CABG surgery, the Eptifibatide infusion should be stopped before surgery.
Aspirin and Heparin Dosing Recommendations. In the clinical trials that showed Eptifibatide to be effective, most patients also received aspirin and heparin. The recommended aspirin and heparin doses are as follows.
For Acute Coronary Syndrome, aspirin is given as 160 to 325 mg by mouth initially and then daily thereafter. For heparin, the target aPTT is 50 to 70 seconds during medical management: patients weighing more than 70 kg receive a 5000 U bolus followed by an infusion of 1000 U/hr, while patients weighing less than 70 kg receive a 60 U/kg bolus followed by an infusion of 12 U/kg/hr. During PCI, the target ACT is 200 to 300 seconds; if heparin was started before the PCI, additional boluses are given during the procedure to keep the ACT within this target, and continuing the heparin infusion after PCI is discouraged.
For PCI, aspirin is given as 160 to 325 mg by mouth 1 to 24 hours before the procedure and then daily thereafter. For heparin, the target ACT is 200 to 300 seconds: patients not treated with heparin within 6 hours before PCI receive an initial 60 U/kg bolus, with additional boluses given during the procedure to keep the ACT within target; continuing the heparin infusion after PCI is strongly discouraged. Patients who require thrombolytic therapy should have their Eptifibatide infusion stopped.