abciximab

Action

Inhibits fibrinogen binding and platelet-platelet interaction by impeding fibrinogen binding to platelet receptor sites, thereby prolonging bleeding time

Availability

Injection: 2 mg/ml (5-ml vials containing 10 mg)

Indications and dosages

➣ Adjunct to aspirin and heparin to prevent acute cardiac ischemic complications in patients undergoing percutaneous coronary intervention (PCI)

Adults: 0.25 mg/kg I.V. bolus given 10 to 60 minutes before start of PCI, followed by infusion of 0.125 mcg/kg/minute for 12 hours. Maximum dosage is 10 mcg/minute.

➣ Adjunct to aspirin and heparin in patients with unstable angina who haven't responded to conventional medical therapy and will undergo PCI within 24 hours

Adults: 0.25 mg/kg I.V. bolus, followed by 18- to 24-hour infusion of 10 mcg/minute, ending 1 hour after PCI

Contraindications

• Hypersensitivity to drug or murine proteins

• Active internal bleeding

• Bleeding diathesis

• Severe, uncontrolled hypertension

• Thrombocytopenia (< 100,000 cells/mm³)

• Neutropenia

• Aneurysm

• Arteriovenous malformation

• History of cerebrovascular accident

• Oral anticoagulant therapy within past 7 days (unless prothrombin time is < 1.2 times control)

Precautions

Use cautiously in:

• patients receiving drugs that affect hemostasis (such as thrombolytics, anticoagulants, or antiplatelet drugs)

• pregnant or breastfeeding patients.

Administration

• I.V. bolus dose may be given undiluted. For I.V. infusion, further dilute the desired dose with normal saline or D₅W.

• Give through separate I.V. line with no other drugs.

• Avoid noncompressible I.V. sites, such as subclavian or jugular vein.

See Stop continuous infusion after failed PCI.

• Restrict patient to bed rest for 6 to 8 hours after drug withdrawal or 4 hours after heparin withdrawal (whichever occurs first).

• After catheter removal, apply pressure to femoral artery for at least 30 minutes.

Adverse reactions

CNS: dizziness, anxiety, agitation, abnormal thinking, hypoesthesia, difficulty speaking, confusion, weakness, cerebral ischemia, coma

CV: pseudoaneurysm, palpitations, vascular disorders, arteriovenous fistula, hypotension, peripheral edema, weak pulse, intermittent claudication, bradycardia, ventricular or supraventricular tachycardia, atrial fibrillation or flutter, atrioventricular block, nodal arrhythmias, pericardial effusion, embolism, thrombophlebitis

EENT: abnormal or double vision

GI: nausea, vomiting, diarrhea, constipation, dyspepsia, ileus, gastroesophageal reflux, enlarged abdomen, dry mouth

GU: urinary tract infection, urine retention or urinary incontinence, painful or frequent urination, abnormal renal function, cystalgia, prostatitis Hematologic: anemia, leukocytosis, thrombocytopenia, bleeding

Metabolic: diabetes mellitus, hyperkalemia

Musculoskeletal: myopathy, myalgia, increased muscle tension, reduced muscle stretching ability

Respiratory: pneumonia, crackles, rhonchi, bronchitis, pleurisy, pleural effusion, bronchospasm, pulmonary edema, pulmonary embolism

Skin: pallor, cellulitis, petechiae, pruritus, bullous eruptions, diaphoresis

Other: abscess, peripheral coldness, development of human antichimeric antibodies

Interactions

Drug-drug. Drugs that affect hemostasis (such as aspirin, dextran, dipyridamole, heparin, nonsteroidal anti-inflammatory drugs, oral anticoagulants, thrombolytics, and ticlopidine): increased bleeding risk

Drug-diagnostic tests. Activated partial thromboplastin time (APTT), clotting time, prothrombin time (PT): increased values

Platelets: decreased count

Patient monitoring

• Assess platelet count before, during, and after therapy.

See Monitor catheter insertion site frequently for bleeding.

See During catheter insertion and for 6 hours after catheter removal, frequently monitor digital pulse in leg where catheter was inserted.

• Monitor CBC, PT, APTT, and International Normalized Ratio.

• Minimize arterial or venous punctures, automatic blood pressure cuff use, I.M. injections, nasotracheal or nasogastric intubation, and urinary catheterization.

• Use indwelling venipuncture device, such as heparin lock, to draw blood.

Patient teaching

• Tell patient what to expect during and after drug administration.

• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.

See Instruct patient to immediately report unusual bleeding or bruising.

• Caution patient to avoid activities that may cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.

• Inform patient that he'll undergo regular blood testing during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.