Anti-platelet Agents

abciximab (Reopro ®):

Platelet aggregation inhibition: (PCI): 0.25 mg/kg IV 10–60 minute prior to PCI, then 0.125 mcg/kg/minute (Maximum 10 mcg/min) IV Infusion x 12 hours.

The safety and efficacy of Abciximab have only been investigated with concomitant administration of heparin and aspirin as described in CLINICAL STUDIES.  In patients with failed PCls, the continuous infusion of Abciximab should be stopped because there is no evidence for Abciximab efficacy in that setting.  In the event of serious bleeding that cannot be controlled by compression, Abciximab and heparin should be discontinued immediately.

Filter the bolus injection using a sterile, non-pyrogenic, low protein-binding 0.2 or 0.22 m m filter (Millipore SLGV025LS or equivalent).

Aggrenox ® (dipyridamole/ASA):
 INDICATIONS:  AGGRENOX (aspirin/extended-release dipyridamole) is indicated to reduce the risk of stroke in patients who have had transient ischemia of the brain or completed ischemic stroke due to thrombosis.

DOSAGE AND ADMINISTRATION:  The recommended dose of AGGRENOX (aspirin/extended-release dipyridamole) is one capsule given orally twice daily, one in the morning and one in the evening. The capsules should be swallowed whole without chewing. AGGRENOX capsules may be administered with or without food.

AGGRENOX is not interchangeable with the individual components of aspirin and Persantine® Tablets.

Supplied:  Each hard gelatin capsule contains 200 mg dipyridamole in an extended-release form and 25 mg aspirin, as an immediate-release sugar-coated tablet.   [200 mg /25 mg]

anagrelide (Agrylin ®):
 INDICATIONS:   AGRYLIN Capsules are indicated for the treatment of patients with thrombocythemia, secondary to myeloproliferative disorders, to reduce the elevated platelet count and the risk of thrombosis and to ameliorate associated symptoms including thrombo-hemorrhagic events.

DOSAGE AND ADMINISTRATION:  Treatment with AGRYLIN Capsules should be initiated under close medical supervision. The recommended starting dosage of AGRYLIN is 0. 5 mg orally four times daily or 1 mg orally twice daily which should be maintained for at least one week. Dosage should then be adjusted to the lowest effective dosage required to reduce and maintain platelet count below 600,000/L, and ideally to the normal range. The dosage should be increased by not more than 0.5 mg/day in any one week. Dosage should not exceed 10 mg/day or 2.5 mg in a single dose.

Supplied: [ 0.5 mg , 1 mg  capsule]

cilostazol (Pletal ®)

Antiplatelet agent. Phosphodiesterase III inhibitor => increased cyclic AMP => inhibition of platelet aggregation and vasodilation. Other effects of phosphodiesterase III inhibition include increased cardiac contractility, accelerated AV nodal conduction, increased ventricular automaticity, heart rate, and coronary blood flow.

Dosing (Adults): Peripheral vascular disease: 100 mg orally twice daily taken at least 30 minutes before or 2 hours after breakfast and dinner. Dosage should be reduced to 50 mg twice daily during concurrent therapy with inhibitors of CYP3A4 or CYP2C19.

Supplied: 50 mg, 100 mg tablet.

clopidogrel (Plavix ® ):

INDICATIONS:  Plavix (clopidogrel bisulfate) is indicated for the reduction of atherothrombotic events as follows:

* Recent MI, Recent Stroke or Established Peripheral Arterial Disease:  For patients with a history of recent myocardial infarction (MI), recent stroke, or established peripheral arterial disease, Plavix has been shown to reduce the rate of a combined endpoint of new ischemic stroke (fatal or not), new MI (fatal or not), and other vascular death.
* Acute Coronary Syndrome:   For patients with non-ST-segment elevation acute coronary syndrome (unstable angina/non-Q-wave MI) including patients who are to be managed medically and those who are to be managed with percutaneous coronary intervention (with or without stent) or CABG, Plavix has been shown to decrease the rate of a combined endpoint of cardiovascular death, MI, or stroke as well as the rate of a combined endpoint of cardiovascular death, MI, stroke, or refractory ischemia.
For patients with ST-segment elevation acute myocardial infarction, Plavix has been shown to reduce the rate of death from any cause and the rate of a combined endpoint of death, re-infarction or stroke. This benefit is not known to pertain to patients who receive primary angioplasty.

DOSAGE AND ADMINISTRATION:
Recent MI, Recent Stroke, or Established Peripheral Arterial Disease
The recommended daily dose of Plavix is 75 mg once daily.

Acute Coronary Syndrome
For patients with non-ST-segment elevation acute coronary syndrome (unstable angina/non-Q-wave MI), Plavix should be initiated with a single 300-mg loading dose and then continued at 75 mg once daily. Aspirin (75 mg-325 mg once daily) should be initiated and continued in combination with Plavix. In CURE, most patients with Acute Coronary Syndrome also received heparin acutely.

For patients with ST-segment elevation acute myocardial infarction, the recommended dose of Plavix is 75 mg once daily, administered in combination with aspirin, with or without thrombolytics. Plavix may be initiated with or without a loading dose (300 mg was used in CLARITY --  Review CLINICAL STUDIES).

Plavix can be administered with or without food.
No dosage adjustment is necessary for elderly patients or patients with renal disease.

Supplied:  75 mg,  300 mg tablet.

dipyridamole (Persantine ®):

INDICATIONS:  Dipyridamole is indicated as an adjunct to coumarin anticoagulants in the prevention of postoperative thromboembolic complications of cardiac valve replacement.
DOSAGE AND ADMINISTRATION:
Adjunctive Use in Prophylaxis of Thromboembolism after Cardiac Valve Replacement

The recommended dose is 75-100 mg four times daily as an adjunct to the usual warfarin therapy. Please note that aspirin is not to be administered concomitantly with coumarin anticoagulants.

Supplied:  25 mg, 50 mg and 75 mg tablets.

eptifabatide (Integrilin ®):

ADMINISTRATION:

Administration: Bolus: withdraw dose from 10ml vial and give by IV push over 1-2 minutes. Continuous infusion: administer calculated rate directly from 100ml vial.

Properties: Onset: within 1 hr. T1/2 = 2.5 hours. Platelet fcn restored in @ 4hours after discontinuation. [Supplied: 0.75 mg/ml (100ml) vial. 20 mg/10 ml vial.]

DOSAGE
Acute Coronary Syndrome: The recommended adult dosage of eptifibatide in patients with acute coronary syndrome and normal renal function is an intravenous bolus of 180 µg/kg (maximum: 22.6 mg) over 1-2 minutes as soon as possible following diagnosis, followed by a continuous infusion of 2.0 µg/kg/min (maximum: 15 mg/hour) until hospital discharge or initiation of CABG surgery, up to 72 hours. If a patient is to undergo a percutaneous coronary intervention (PCI) while receiving eptifibatide, the infusion should be continued up to hospital discharge, or for up to 18-24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy. Concurrent aspirin (160-325 mg initially and daily thereafter) and heparin therapy (target aPTT 50-70 seconds) are recommended.

Dosing adjustment in renal impairment: Patients with CRCL less than 50 ml/min: The recommended adult dosage of eptifibatide in patients with acute coronary syndrome with an estimated CRCL <50 ml/min (using the Cockcroft-Gault equation) is an IV bolus of 180 µg/kg (maximum: 22.6 mg) as soon as possible following diagnosis, immediately followed by a continuous infusion of 1.0 µg/kg/min (maximum: 7.5 mg/hour).

Percutaneous Coronary Intervention (PCI): The recommended adult dosage of eptifibatide in patients with normal renal function is an intravenous bolus of 180 µg/kg (maximum: 22.6 mg) over 1-2 minutes administered immediately before the initiation of PCI followed by a continuous infusion of 2.0 µg/kg/min (maximum: 15 mg/hour) and a second 180 µg/kg bolus (maximum: 22.6 mg) 10 minutes after the first bolus. Infusion should be continued until hospital discharge, or for up to 18 to 24 hours, whichever comes first. A minimum of 12 hours of infusion is recommended. Concurrent aspirin (160-325 mg 1-24 hours before PCI and daily thereafter) and heparin therapy (ACT 200-300 seconds during PCI) are recommended. Heparin infusion after PCI is discouraged.
Dosing adjustment in renal impairment: Patients with CRCL less than 50 mL/min: The recommended adult dose of eptifibatide in patients with an estimated CRCL < 50 ml/min (using the Cockcroft-Gault equation) is an IV bolus of 180 µg/kg (maximum: 22.6 mg) administered immediately before the initiation of the procedure, immediately followed by a continuous infusion of 1.0 µg/kg/min (maximum: 7.5 mg/hour) and a second 180 µg/kg bolus (maximum: 22.6 mg) administered 10 minutes after the first. In patients who undergo coronary artery bypass graft surgery, eptifibatide infusion should be discontinued prior to surgery.


Use the Cockcroft-Gault equation with actual body weight to calculate CRCL:

Males:
[(140 – age) x (actual body wt in kg) ]
----------------------------------------
72 x (serum creatinine)

Females:
[(140 – age) x (actual body wt in kg) x (0.85)]
----------------------------------------------
72 x (serum creatinine)

ticlopidine (Ticlid ®):
 INDICATIONS:
--To reduce the risk of thrombotic stroke (fatal or nonfatal) in patients who have experienced stroke precursors, and in patients who have had a completed thrombotic stroke. Because TICLID is associated with a risk of life-threatening blood dyscrasias including thrombotic thrombocytopenic purpura (TTP), neutropenia/agranulocytosis and aplastic anemia, TICLID should be reserved for patients who are intolerant or allergic to aspirin therapy or who have failed aspirin therapy.

--As adjunctive therapy with aspirin to reduce the incidence of subacute stent thrombosis in patients undergoing successful coronary stent implantation.

DOSAGE AND ADMINISTRATION:
Stroke: The recommended dose of TICLID is 250 mg bid taken with food. Other doses have not been studied in controlled trials for these indications.

Coronary Artery Stenting: The recommended dose of TICLID is 250 mg bid taken with food together with antiplatelet doses of aspirin for up to 30 days of therapy following successful stent implantation.

Supplied:  250 mg tablet.

tirofiban (Aggrastat ®):

Dosing: 0.4 mcg/kg/min for 30 minutes, followed by 0.1 mcg/kg/min. Therapy should continue through angiography and for 12-24 hours after angioplasty or atherectomy.

Dosing adjustment in renal impairment:
(Note: Reduce dose by 50% if CRCL < 30 ml/min - 0.2 mcg/kg/min x 30 min, followed by 0.05 mcg/kg/min).

Preparation: Add 12.5 mg (50 ml) to 200ml NS or D5W. Total volume= 250ml. Concentration= 50 mcg/ml. Or add 25 mg (100ml) to 400 ml D5W or NS.

Supplied: 250 mcg/ml-50 ml vial (12.5 mg/50ml).
 

Disclaimer
Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.

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