Abciximab (Intravenous)

As a glycoprotein IIb/IIIa receptor agonist, Abciximab is a platelet aggregation inhibitor which is typically used to stop platelets from bunching together and causing blood clots.

Overview

Abciximab is primarily used during and after invasive heart treatments, such as angioplasty, in order to protect the arteries and to lower the risk of heart attack in those with angina. It is manufactured from the Fab fragments of immunoglobin which target glycoprotein IIb/IIIa receptors on platelet membranes, and functions by preventing platelets from clotting. This prevents arteries from becoming blocked post-operation. It is not suitable for use during emergency surgery, because bleeding can take 12 hours to normalize after taking the medicine.

The use of Abciximab is indicated for patients who are undergoing coronary intervention (with or without the use of stents). In these instances, Abciximab is associated with a decrease in ischemic complications which can arise during procedures, along with a decrease in the need for coronary artery revascularization during the first month after the procedure.

The drug is administered intravenously via a bolus or drip, and it has a very short plasma half-life. Due to its strong affinity for receptors on the platelets however, it can potentially occupy some receptors for a period of weeks. Platelet aggregation typically returns to normal approximately 96 hours after discontinuing Abciximab use.

Research also suggests that the drug can be useful in the treatment of patients with chronic renal insufficiency and diabetes, although these “off-label” uses are strictly at the discretion of a doctor or qualified health professional, and great care should be taken, with monitoring in place, before undergoing off-label use of Abciximab.

Conditions treated:

  • Thrombus
  • Angina
  • Diabetes
  • Chronic renal insufficiency

Type of medicine:

  • Platelet aggregation inhibitor

Side effects

Along with the desired effects, Abciximab has the potential to cause one or more unwanted side effects. Not all of the side effects experienced are serious, although some may require medical attention. The most common side effects reported by patients undergoing treatment with Abciximab include blurred vision, dizziness, confusion, light-headedness, feeling faint when getting up suddenly from a sitting or lying position, tiredness, weakness, excess sweating and bleeding.

As the patient continues with a dose as directed by a physician, most or all of the aforementioned side effects will lessen as the body adjusts to the medication. In the event of any side effects failing to subside or even worsening as treatment goes on, the patient is encouraged to contact their doctor immediately to make them aware, as this could be the sign of an adverse reaction to the medicine.

The majority of patients experience minimal side effects while being treated with Abciximab, and will typically begin treatment while under observation in a post-operation environment at a hospital. This provides a safe environment where any side effects can be immediately highlighted to healthcare professionals overseeing the convalescence of the patient.

Other side effects are experienced very rarely, but often enough to warrant mentioning. These include:

  • Tarry, black stools
  • Bleeding gums
  • Blood in stools or urine
  • A red rash on the skin
  • Unusual bruising or bleeding
  • Sneezing
  • Sore throat
  • Pale skin
  • Weight gain
  • Eye pain
  • Fevers or chills

Some patients may experience hypersensitivity during treatment with Abciximab which can present itself as anaphylaxis. In the event of this happening, the patient may require treatment with epinephrine, antihistamine, dopamine and/or corticosteroid therapy.

Gastrointestinal issues have also been reported in approximately 14% of patients, who experienced vomiting, nausea and acid reflux. A course of proton pump inhibitors is recommended in this instance.

Dosage

Like all medicines, Abciximab should only be administered as prescribed by a qualified health professional. This means that the patient should not receive more of the drug than advised, and should only receive the drug at a frequency determined by a doctor.

Abciximab is available as an injectable solution, administered intravenously via a drip at a concentration of 2mg per mL. Dosage will vary depending on the physiology of the patient, and should be overseen by a nurse, doctor or professional caregiver. The strength of the solution administered, and the number of doses should be decided at the discretion of a doctor who should be able to draw up a treatment plan for the weeks and months after invasive coronary surgery.

While the manufacturer of Abciximab may provide general instructions regarding doses, it should be reiterated that these can be altered in order to best suit the requirements of the patient.

As an adjunct to PCI, a patient can expect to receive 0.25mg/kg via IV bolus for a minute, approximately 10-60 minutes prior to invasive coronary surgery. This is followed by a 0.125mg/kg per minute continuous IV infusion over a 12-hour period, which should not exceed an infusion rate of 10 mcg per minute.

Patients suffering from unstable angina who are about to undergo invasive coronary surgery may require a different dose in order to prevent cardiac complications which may arise in patients with unstable angina. Typically, this involves a 0.25mg/kg IV bolus for at least one minute, followed by a continuous IV infusion of 0.125 mcg/kg per minute of Abciximab for a period of 18 to 24 hours. This should not exceed 10 mcg/min.

Abciximab is used off-label during adjunctive therapy for thrombosis. The dosage should be decided at the discretion of a doctor.

Overdose of Abciximab is unlikely, given that it is usually administered by a doctor or healthcare professional in a hospital setting. However, in the event of overdose of Abciximab or any other medication, patients are advised to contact the Poison Control Center (1800-222-1222) or the emergency services (911) as immediate attention may be required in order to prevent serious injury or risk of death.

Interactions

Medications can potentially interact with chemicals or other medicines present in the human body, and this can change the efficacy of the medicine or increase the propensity of side effects. In some instances, interactions can even cause side effects not typically associated with either medicine.

Interactions can cause serious complications and can even potentially be fatal. For these reasons, it is imperative that patients keep a detailed list of every medication they are currently taking, down to the frequency and dose size of each medicine. This not only applies to prescribed medicines, but to over-the-counter remedies, supplements and herbs too.

Below is a partial list of medications known to have interacted negatively with Abciximab. Patients who are currently taking one or more of these drugs should notify their doctor immediately before being administered with the initial intravenous dose of Abciximab:

  • Aptivus
  • Anagrelide
  • Arixtra
  • Aspirin
  • Bexxar
  • Coumadin
  • Dabigatran
  • Dextran
  • Effient
  • Farydak
  • Gentran 40
  • Heparin
  • Iprivask
  • Jadenu
  • Lovenox
  • Miradon
  • Normiflo
  • Pradaxa
  • Reteplase
  • Synribo
  • Tipranavir
  • Ticlopidine
  • Warfarin

Other medications may cause moderate or minor interactions when used in conjunction with Abciximab. While the side effects produced as a result of this may not cause much discomfort, care should be taken by healthcare providers in order to monitor for any potentially serious changes in coagulation or platelet level. Medicines which are known to cause minor interactions with Abciximab include:

  • Aquasol
  • Advil
  • Alka-Seltzer
  • Citric acid
  • Naproxen
  • Blowfish hangover remedy
  • Choline magnesium
  • Citalopram
  • Dramamine
  • Esomeprazole
  • Fluoxetine
  • Ginger root
  • Ibuprofen
  • Ketamine
  • Caffeine

Patients should ensure that doctors are aware if they are taking these drugs, along with any other acid reflux treatments or selective serotonin reuptake inhibitors (SSRIs) for depression, as one of the side effects of these medicines is that they can cause thinning of the blood. In conjunction with Abxciximab, this can cause excess bleeding.

Warnings

Patients with certain recent health conditions should not be prescribed Abciximab, or should be monitored for potentially life-threatening contraindications. Extreme care should be given when administering the drug to patients who have recently suffered from trauma or major surgery (in the past 6 weeks), patients who have a recent history of bleeding diathesis (in the past 6 weeks), patients who have recently suffered a stroke (in the past 4 weeks), patients with active internal bleeding, or recent significant genitourinary or gastrointestinal bleeding (within the past 6 weeks). In these instances, haemoglobin and haematocrit levels of the patient should be monitored, along with platelet count and prothrombin time.

Additionally, healthcare professionals should be informed of any addictions the patient may have experienced, including any which required treatment in a rehabilitation program. Substances such as alcohol can cause thinning of the blood which can affect the way in which Abciximab functions, and could increase the risk of potentially harmful side effects. Abciximab can potentially increase the risk of bleeding, particularly when anticoagulation agents such as Warfarin are also administered. The bleeding typically presents itself as an intercranial haemorrhage.

Abciximab has been classified as a category C risk by the FDA. This means that it is currently unknown whether the medicine can cause fetal harm when prescribed to a pregnant woman, or whether it affects the capacity to reproduce. While no data exists on the excretion of the drug into human breastmilk, the manufacturer nevertheless recommends that caution be taken when administering Abciximab to women who are currently nursing infants.

Storage

Abciximab should be stored in a refrigerator between 2C and 8C (36F to 46F). The solution should never be frozen, and any liquid which inadvertently freezes (due to weather conditions or refrigeration faults) should be destroyed. Liquid which is unused after a treatment should also be discarded in a safe, and efficient manner, so that children or pets, for example, cannot access it.

This medication, like all others, should not be flushed down the toilet or poured into a drain. It should be properly discarded as hazardous waste. Because Abciximab is generally administered in hospitals, it will likely be the responsibility of your healthcare provider to correctly dispose of unused or unwanted Abciximab, but in the event of having to personally dispose of it, you should contact your local waste disposal company or pharmacist for advice on how to safely discard your unwanted medication. Some pharmacies offer a take-back scheme, which can result in medicines being re-used.

Summary

Abciximab, which is sometimes marketed in the United States as Reopro, is a colorless, clear liquid solution which is used for direct injection or infusion via a drip, in order to prevent ischemic cardiac issues in patients who are undergoing invasive coronary intervention. It can also be used as a short-term means of reducing the risk of myocardial infarction in patients suffering from unstable angina prior to undergoing percutaneous coronary intervention.

This medication should only be used on adults, and in conjunction with specialist nursing care and medical expertise. In addition to this, healthcare providers should only administer Abciximab when laboratory tests of haematology function are available, along with a facility for the storage and administration of blood products. This means that patients are most likely to receive treatment with Abciximab in hospitals, under the expert care of qualified physicians.

Abciximab has been used in hospitals around the world for the best part of 20 years, since its approval by the FDA in November 1997. It is effective in preventing clotting and assisting surgeons in balloon angioplasty, stent placement and atherectomy, and is used in invasive procedures multiple times a day by health professionals. If you have any concerns about Abciximab, or if you are currently taking medication which you feel may interact with it, you should discuss these issues with your doctor prior to commencing treatment.

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Last Reviewed:
December 10, 2017
Last Updated:
April 04, 2018
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