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addiction [20%:<100,000 cells/mcL); recent (within 6 weeks) major surgery or trauma; intracranial tumor, arteriovenous malformation, or aneurysm; severe uncontrolled hypertension; history of vasculitis (presumed or documented); use of dextran before PCI or intent to use dextran during PCI. Dosing: Adult Percutaneous coronary intervention (PCI): IV: 0.25 mg/kg bolus administered 10 to 60 minutes prior to start of PCI followed by an infusion of 0.125 mcg/kg/minute (maximum: 10 mcg/minute) for 12 hours Unstable angina/non-ST-elevation MI (UA/NSTEMI) unresponsive to conventional medical therapy with planned PCI within 24 hours: IV: 0.25 mg/kg bolus followed by an 18- to 24-hour infusion of 10 mcg/minute, concluding 1 hour after PCI. ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) (off-label use) (ACCF/AHA [O'Gara 2013]): IV: Loading dose: 0.25 mg/kg bolus administered at the time of PCI Maintenance infusion: 0.125 mcg/kg/minute (maximum: 10 mcg/minute) continued for up to 12 hours Intracoronary (off-label route): 0.25 mg/kg bolus administered directly to the site of the infarct lesion; may be followed with an intravenous maintenance infusion if refractory intraprocedural thrombotic complications occur (Stone 2012) Dosing: Geriatric Refer to adult dosing. Dosing: Renal Impairment There are no dosage adjustments provided in the manufacturer's labeling. Hemodialysis: Dialyzable: Unknown, but unlikely (NCS/SCCM [Frontera 2016]) Dosing: Hepatic Impairment There are no dosage adjustments provided in the manufacturer's labeling. Reconstitution Bolus dose: Withdraw required amount of abciximab into a syringe using a 0.2 or 5 micron low protein-binding syringe filter (or equivalent); the bolus should be administered 10 to 60 minutes before the procedure. Continuous infusion: Withdraw required amount of abciximab into a syringe using a 0.2 or 5 micron low protein-binding syringe filter (or equivalent) and inject into an appropriate container of NS or D5W. If a syringe filter was not used to prepare the infusion, administer using an in-line 0.2 or 0.22 micron low protein-binding filter. Note: A standard concentration of 7.2 mg in 250 mL of NS or D5W may also be prepared for all patients and administered at the standard dose (0.125 mcg/kg/minute; maximum: 10 mcg/minute) with a variable rate in mL/hour. Infuse for 12 to 24 hours via pump after bolus dose; length of therapy dependent on indication. Some institutions use a standard concentration of 9 mg in 250 mL of D5W or NS. Administration For IV administration. Solution must be filtered using a 0.2 or 5 micron low protein-binding syringe filter during preparation or via a 0.2 to 0.22 micron low protein-binding inline filter during administration. Do not shake vial. Intracoronary administration (off-label route): In select STEMI cases (eg, anterior STEMI), abciximab bolus may be administered through the guiding catheter directly to the culprit lesion site (Stone 2012; Thiele 2012) Storage Store intact vials at 2 C to 8 C (36 F to 46 F). Do not freeze or shake. After admixture in NS or D5W, the prepared solution is stable for 12 hours. Discard any unused portion. The following stability information has also been reported: May store intact vials at 24 C to 28 C (76 F to 82 F) for up to 8 days (data on file [Eli Lilly, 2011]). However, the manufacturer recommends storage under refrigeration. Room temperature stability information should only be utilized in situations where the drug has been inadvertently exposed to prolonged room temperature. Drug Interactions Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): May enhance the antiplatelet effect of other Agents with Antiplatelet Properties. Monitor therapy Anticoagulants: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Monitor therapy Apixaban: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Apixaban. Specifically, the risk for bleeding may be increased. Management: Carefully consider risks and benefits of this combination and monitor closely. Monitor therapy Belimumab: Monoclonal Antibodies may enhance the adverse/toxic effect of Belimumab. Avoid combination Cephalothin: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased. Monitor therapy Collagenase (Systemic): Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased. Monitor therapy Dabigatran Etexilate: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Dabigatran Etexilate. Agents with Antiplatelet Properties may increase the serum concentration of Dabigatran Etexilate. This mechanism applies specifically to clopidogrel. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor. Monitor therapy Dasatinib: May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Monitor therapy Deoxycholic Acid: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased. Monitor therapy Dextran: May enhance the anticoagulant effect of Abciximab. Avoid combination Edoxaban: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Monitor therapy Glucosamine: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Consider therapy modification Ibritumomab: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab. Both agents may contribute to impaired platelet function and an increased risk of bleeding. Monitor therapy Ibrutinib: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Monitor therapy Limaprost: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Multivitamins/Fluoride (with ADE): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Multivitamins/Minerals (with AE, No Iron): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Obinutuzumab: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased. Monitor therapy Omega-3 Fatty Acids: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Pentosan Polysulfate Sodium: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents. Monitor therapy Pentoxifylline: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Prostacyclin Analogues: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Rivaroxaban: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Rivaroxaban. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor. Monitor therapy Salicylates: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result. Monitor therapy Thrombolytic Agents: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents. Monitor therapy Tipranavir: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Tositumomab and Iodine I 131 Tositumomab: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Tositumomab and Iodine I 131 Tositumomab. Specifically, the risk of bleeding-related adverse events may be increased. Monitor therapy Urokinase: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase. Avoid combination Vitamin E (Systemic): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy Adverse Reactions As with all drugs which may affect hemostasis, bleeding is associated with abciximab. Hemorrhage may occur at virtually any site. Risk is dependent on multiple variables, including the concurrent use of multiple agents which alter hemostasis and patient susceptibility.> 10%: Cardiovascular: Hypotension (14%), chest pain (11%) Gastrointestinal: Nausea (14%) Hematologic & oncologic: Minor hemorrhage (4% to 17%), major hemorrhage (1% to 14%) Neuromuscular & skeletal: Back pain (18%) Miscellaneous: Antibody development (HACA, first exposure: 6%; readministration: 27%; four or more exposures: 44%) 1% to 10%: Cardiovascular: Bradycardia (5%), peripheral edema (2%) Gastrointestinal: Abdominal pain (3%) Hematologic & oncologic: Thrombocytopenia: <100,000 cells/mm 3 (3% to 6%);> <50,000 cells/mm 3 (0.4% to 2%) Local: Pain at injection site (4%)> <1% (Limited to important or life-threatening): Abnormality in thinking, abscess, allergic reaction (possible), anaphylaxis (possible), arteriovenous fistula, bronchitis, bullous skin disease, cellulitis, cerebrovascular accident, coma, complete atrioventricular block, confusion, diabetes mellitus, edema, embolism, gastroesophageal reflux disease, hyperkalemia, hypertonia, incomplete atrioventricular block, inflammation, intestinal obstruction, intracranial hemorrhage, leukocytosis, nodal arrhythmia, pleural effusion, pleurisy, pneumonia, prostatitis, pseudoaneurysm, pulmonary alveolar hemorrhage, pulmonary embolism, renal insufficiency, thrombophlebitis, urinary retention, ventricular tachycardia Warnings/Precautions Concerns related to adverse effects: Anaphylaxis/hypersensitivity reactions: Administration may result in human antichimeric antibody formation that can cause hypersensitivity reactions (including anaphylaxis [rare], sometimes fatal). Bleeding: The most common complication is bleeding, including retroperitoneal, pulmonary, and spontaneous GI and/or GU bleeding; monitor closely for bleeding, especially the arterial access site for the cardiac catheterization. Use with extreme caution in patients with platelet counts> <150,000/mm 3 , hemorrhagic retinopathy, previous history of GI disease, recent thrombolytic therapy and in chronic dialysis patients. Use caution with administration of other drugs affecting hemostasis. Minimize other procedures, including arterial and venous punctures, IM injections, use of urinary catheters, nasogastric tubes, and automatic blood pressure cuffs. Increased risk of hemorrhage during or following angioplasty is associated with unsuccessful PCI, PCI procedure> 70 minutes duration, or PCI performed within 12 hours of symptom onset for acute myocardial infarction. When attempting IV access, avoid noncompressible sites (eg, subclavian or jugular veins). If serious uncontrolled bleeding or the need for emergency surgery arises, discontinue abciximab. Thrombocytopenia: Administration may result in human antichimeric antibody formation that can cause thrombocytopenia, including severe cases; immediately discontinue if thrombocytopenia occurs. Readministration within 30 days or in patients with human antichimeric antibodies (HACA) increases the incidence and severity of thrombocytopenia. Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Special populations: Elderly: Use with caution in patients >65 years; may have increased risk of bleeding. Low weight patients: Use with caution in patients weighing <75 kg; may have increased risk of bleeding. Other warnings/precautions: Diminished efficacy: Administration may result in human antichimeric antibody formation that can cause diminished efficacy upon readministration. Sheath removal: Discontinuation of heparin immediately upon completion of the procedure and removal of the sheath within 6 hours is strongly recommended as long as ACT> <150 to 180 seconds or aPTT> <50 seconds (ACCF/AHA/SCAI [Levine 2011]). Use standard compression techniques after sheath removal. Monitor the site closely afterwards for further bleeding. Surgery: Discontinue 12 hours prior to coronary artery bypass graft surgery (ACC/AHA [Amsterdam 2014]). Monitoring Parameters Prothrombin time, activated partial thromboplastin time (aPTT), hemoglobin, hematocrit, platelet count, fibrinogen, fibrin split products, transfusion requirements, signs of hypersensitivity reactions, guaiac stools, Hemastix urine. Platelet count should be monitored at baseline, 2 to 4 hours following bolus infusion, and at 24 hours (or prior to discharge, if before 24 hours). To minimize risk of bleeding: Abciximab initiated 18 to 24 hours prior to PCI: Maintain aPTT between 60 to 85 seconds during the heparin/abciximab infusion period During PCI: Maintain ACT between 200 to 300 seconds Following PCI (if anticoagulation is maintained): Maintain aPTT between 50 to 75 seconds Sheath removal should not occur until aPTT is 50 seconds or ACT 175 seconds. Maintain bleeding precautions, avoid unnecessary arterial and venous punctures, use saline or heparin lock for blood drawing, assess sheath insertion site and distal pulses of affected leg every 15 minutes for the first hour and then every 1 hour for the next 6 hours if femoral access utilized for percutaneous coronary intervention. Arterial access site care is important to prevent bleeding. Care should be taken when attempting vascular access that only the anterior wall of the femoral artery is punctured, avoiding a Seldinger (through and through) technique for obtaining sheath access. Femoral vein sheath placement should be avoided unless needed. While the vascular sheath is in place, patients should be maintained on complete bedrest with the head of the bed at a 30 angle and the affected limb restrained in a straight position. Observe patient for mental status changes, hemorrhage; assess nose and mouth mucous membranes, puncture sites for oozing, ecchymosis, and hematoma formation; examine urine, stool, and emesis for presence of occult or frank blood; gentle care should be provided when removing dressings. Pregnancy Risk Factor C Pregnancy Considerations Animal reproduction studies have not been conducted. In vitro studies have shown only small amounts of abciximab to cross the placenta (Miller 2003). Information related to the use of abciximab in pregnancy is limited (Santiago-Diaz 2009; Sebastian 1998). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience back pain, nausea, vomiting, or headache. Have patient report immediately to prescriber signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; hematuria; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding), severe dizziness, passing out, angina, bradycardia, fall or crash hitting head, or severe loss of strength and energy (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients. Next Interactions Print this page Add to My Med List More about abciximab Side Effects During Pregnancy Drug Interactions Support Group 0 Reviews Add your own review/rating Drug class: glycoprotein platelet inhibitors Consumer resources Abciximab Abciximab Intravenous (Advanced Reading) Professional resources Abciximab (AHFS Monograph) Other brands: ReoPro Related treatment guides High Risk Percutaneous Transluminal Angioplasty> ]} Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Abciximab Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Drug Class Glycoprotein platelet inhibitors Related Drugs glycoprotein platelet inhibitors Integrilin , tirofiban , Aggrastat , eptifibatide , ReoPro High Risk Percutaneous Transluminal Angioplasty ReoPro , More...} } reliable


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