Indications & Uses
Integril is indicated for:
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
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.
Side Effects
Bleeding is the most common side effect. More serious reactions can include bleeding inside the skull (intracranial hemorrhage) and stroke, a drop in platelet count (thrombocytopenia), allergic reactions, and low blood pressure.
Cautions & Contraindications
Warnings & Precautions
In patients having a PCI (percutaneous coronary intervention) procedure, Integril Injection is linked to a higher risk of major and minor bleeding at the site where the arterial sheath is placed. Extra care should be taken to keep bleeding risk as low as possible in these patients. If bleeding cannot be controlled with pressure, the infusion of Integril and any heparin being given at the same time should be stopped right away. Because Integril works by inhibiting platelet aggregation, caution is needed when it is combined with other drugs that affect blood clotting, including thrombolytics, oral anticoagulants, NSAIDs, and dipyridamole. It should not be used together with other GP IIb/IIIa inhibitors. Integril is partly cleared by the kidneys, and its plasma concentration doubles in patients with kidney disease (creatinine clearance below 50 ml/min). For these patients, the Integril infusion dose should be lowered to 1 mcg/kg/min. Integril should not be used in patients who depend on renal dialysis. Caution is also needed when giving Integril to patients whose platelet count is below 100,000 per cubic millimeter (100,000/mm3). Bleeding is the most common complication seen with Integril therapy, and most excess major bleeding occurs at the femoral artery access site. Bleeding in the mouth and throat, urinary and genital tract, digestive tract, and the area behind the abdominal cavity (retroperitoneal bleeding) was also seen more often with Integril than with placebo. Arterial and venous punctures, intramuscular injections, and the use of urinary catheters, nasotracheal tubes, and nasogastric tubes should be kept to a minimum. When setting up an intravenous line, sites that cannot be compressed, such as the subclavian or jugular veins, should be avoided. Before starting an Integril infusion, the following laboratory tests should be done to check for any existing clotting problems: hematocrit or hemoglobin, platelet count, serum creatinine, and PT/aPTT. In patients undergoing PCI, activated clotting time (ACT) should also be measured.
Contraindications
Contraindications for Eptifibatide include a history of bleeding disorders or any sign of active abnormal bleeding in the past 30 days. It should also be avoided in patients with severe, poorly controlled high blood pressure (systolic above 200 mmHg or diastolic above 110 mmHg despite treatment), or in those who have undergone major surgery within the last 6 weeks. Patients with a stroke in the past 30 days, or any past history of hemorrhagic stroke, should not receive this medicine. It is likewise contraindicated alongside current or planned use of another intravenous GP IIb/IIIa inhibitor, in patients dependent on renal dialysis, and in anyone with known hypersensitivity to any of its ingredients.