Tirofiban Dosing for a 90 kg Male
For a 90 kg male, tirofiban should be administered as a loading dose of 25 μg/kg (2,250 μg) IV bolus over 3 minutes, followed by a maintenance infusion of 0.15 μg/kg/min (13.5 μg/min) for up to 18 hours. 1
Calculation Breakdown
Loading Dose:
- Formula: 25 μg/kg × patient weight (kg)
- Calculation: 25 μg/kg × 90 kg = 2,250 μg (2.25 mg) IV bolus
- Administration: Give over 3 minutes
Maintenance Infusion:
- Formula: 0.15 μg/kg/min × patient weight (kg)
- Calculation: 0.15 μg/kg/min × 90 kg = 13.5 μg/min
- Duration: Continue for up to 18 hours at the discretion of the physician
Special Considerations
Renal Function Adjustment
- If creatinine clearance is < 30 mL/min: Reduce the maintenance infusion by 50% to 0.075 μg/kg/min (6.75 μg/min) 1
- No adjustment needed for the loading dose in renal impairment
Monitoring
- Monitor for bleeding complications, especially in patients with renal impairment 2
- Check platelet count regularly as thrombocytopenia can occur (platelet count < 90,000 cells/μL) 3
Clinical Context
- This dosing regimen is based on the high-dose bolus (HDB) protocol, which provides more rapid and consistent platelet inhibition compared to earlier regimens 4
- Platelet aggregation inhibition is reversible, with function returning to near baseline within 4-8 hours after discontinuation of the infusion 2
- When used with dual antiplatelet therapy, careful monitoring is recommended, especially in patients with elevated creatinine levels 5
Common Pitfalls to Avoid
- Avoid excessive dosing, which is defined as an initial bolus dose > 25 μg/kg or an initial infusion rate > 0.15 μg/kg/min 1
- Do not administer tirofiban if the patient has already received another glycoprotein IIb/IIIa inhibitor (abciximab, eptifibatide) 1
- Ensure accurate measurement of patient weight in kilograms and assessment of renal function before administration 1
Remember that tirofiban should be used as part of a comprehensive antithrombotic strategy in the management of acute coronary syndromes, typically alongside aspirin and other antiplatelet agents.