From the Guidelines
Eptifibatide (Integrilin) begins working almost immediately after intravenous administration, with peak platelet inhibition occurring within 15-30 minutes of starting the infusion. The medication is a glycoprotein IIb/IIIa receptor antagonist that rapidly blocks platelet aggregation by preventing fibrinogen from binding to activated platelets 1. For acute coronary syndromes, Integrilin is typically administered as an initial bolus of 180 mcg/kg, followed by a continuous infusion of 2 mcg/kg/min for up to 72-96 hours 1. A second bolus of 180 mcg/kg is often given 10 minutes after the first bolus to ensure adequate platelet inhibition.
Key Points to Consider
- The rapid onset of action makes Integrilin valuable in emergency situations requiring immediate platelet inhibition, such as during percutaneous coronary interventions 1.
- The medication's effects are reversible, with platelet function returning to normal within 4-8 hours after discontinuation of the infusion, which is important to know when planning surgical procedures or managing bleeding complications.
- The ESPRIT trial evaluated the efficacy and safety of eptifibatide treatment as adjunctive therapy during nonemergency coronary stent implantation, and found a 37% reduction in the 48-h primary composite end point of death, MI, urgent target-vessel revascularization, or bailout treatment with open-label GP IIb/IIIa inhibitor therapy 1.
Administration and Dosage
- The recommended dosage of Integrilin is an initial bolus of 180 mcg/kg, followed by a continuous infusion of 2 mcg/kg/min 1.
- A second bolus of 180 mcg/kg is often given 10 minutes after the first bolus to ensure adequate platelet inhibition 1.
- The infusion should be continued for up to 72-96 hours, depending on the clinical situation 1.
From the FDA Drug Label
The effect of eptifibatide was observed immediately after administration of a 180 mcg/kg intravenous bolus Inhibition of platelet aggregation 15 min after bolus 84% Inhibition of platelet aggregation at steady state >90%
The intravenous administration of eptifibatide starts working immediately after the administration of a 180 mcg/kg intravenous bolus, with significant platelet aggregation inhibition observed within 15 minutes 2.
From the Research
Mechanism of Action
- Eptifibatide, also known as Integrilin, is a highly specific, reversible, intravenously administered glycoprotein IIb/IIIa receptor antagonist that acts at the final common step of the platelet aggregation pathway 3, 4.
- It selectively inhibits the platelet receptor IIb/IIIa, which is essential for platelet aggregation 5.
Onset of Action
- The exact onset of action of intravenous eptifibatide is not explicitly stated in the provided studies.
- However, the studies suggest that eptifibatide is effective in reducing ischemic events in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention 5, 3, 4.
Clinical Efficacy
- Several clinical trials, including the ESPRIT and PURSUIT trials, have demonstrated the efficacy of eptifibatide in reducing death and ischemic complications in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention 5, 3, 4.
- Eptifibatide has been shown to be well tolerated in these trials, with a low incidence of major bleeding and thrombocytopenia 5, 3, 4.
Dosage and Administration
- The dosage and administration of eptifibatide vary depending on the specific clinical trial or patient population 5, 3, 4.
- Typical dosages include a bolus dose followed by a continuous infusion, with the exact dosage and duration of infusion varying depending on the specific clinical context 5, 3, 4.