Tirofiban

Tirofiban is a drug that works as a platelet aggregation inhibitor, and it is always used in a hospital or other clinical setting where the patient is closely monitored and the amount of medication may be adjusted accordingly.

Overview

Tirofiban is a prescription drug that is sold under the brand name Aggrastat. It is a powerful drug that is used by doctors and surgeons to help keep a patient's blood from clotting. Tirofiban works by keeping the platelets in the blood from clustering together which is part of their role in the normal blood clotting process. Platelets in the blood make the blood sticky. When this stickiness is lessened, clotting is impaired. The goal when using tirofiban is to keep clots from forming and causing damage to the heart or other organs.

Tirofiban is used intravenously over a period of time in order to produce the desired effect. During the time of the administration of the drug, the patient will be closely monitored for side effects. During the time this medication is used, the doctor will perform numerous blood tests to determine if the medication is having the correct anti-clotting effect.

There are several medical cases where this drug would need to be used. When a patient comes into the emergency room complaining of chest pain or is actively having a heart attack, tirofiban may be administered to keep clots from blocking the flow of blood to the heart.

When cardiovascular procedures are going to be performed, such as angioplasties or stent placements, the natural clotting mechanism of the blood must be reduced in order for the catheters to move through the arterial system. If clots were to form around the catheters, they could migrate to the heart leading to serious complications. The day or night before the procedures are carried out, a patient will receive a course of this drug to reduce the change of any clotting.

Conditions Treated

  • Myocardial Infarction (Heart Attack)
  • Angina Pectoris (Chest Pain)
  • Blood Clots
  • Tirofiban is used before the following procedures:
  • Angioplasty
  • Stent Placement
  • Arterial Catheterization

Type of Medicine

  • Platelet Aggregation Inhibitor

Side Effects

Tirofiban is a powerful medication, and the drug has a number of potentially serious side effects. The majority of the side effects have to do with excessive bleeding. For instance, those using this drug may notice that they bruise quite easily or that their gums bleed easily when brushing when they had not done so before administration of the drug. Patients may also have prolonged bleeding that is difficult to bring under control when cut. Minor nicks from shaving may bleed extensively. Frequent nosebleeds have been reported. Patients may also notice that blood is "leaking" out around IV ports while on the drug.

More serious bleeding side effects may also occur. There have been reports of patients coughing up blood. Some patients may vomit blood or pass blood in their stools. Blood may leak from the kidneys and become present in the urine. Some have reported blood in the eyes in extreme cases.

In addition to these types of excessive bleeding side effects, there are other side effects noted with tirofiban. Some patients will develop a generalized allergic reaction to the medication. This reaction may result in difficulty breathing and in swelling of the lips and face. If this occurs, the drug will be discontinued immediately.

Pain in various parts of the body is a more common side effect when using tirofiban. Patients have reported severe headaches while the drug is being administered. Also, pain is often reported in the arms, back, and jaw when taking the medication. Pain at the infusion site is quite often reported.

Cardiovascular side effects may occur when taking tirofiban. While using the medication, patients have reported chest pain as well as breathing pain. A fast and irregular heartbeat is possible. On the other hand, slow and irregular heartbeats are possible too.

Generalized swelling has been noted at times. There may be localized swelling as well in the hands, feet, face, arms, legs, and abdomen.

Frequently, less serious side effects occur. The most common of these types of side effects are a persistent headache during the time that the drug is being directly administered.

Many of the side effects that are reported with tirofiban are transitory in nature. Since this drug is administered in a hospital or a clinical setting, the healthcare practitioners will be able to monitor the patient closely. If significant side effects develop, the drug can be discontinued, or the dosage of the drug can be modified in order to bring any serious side effects under control. Side effects that are not as serious may not necessitate the discontinuation of the drug or altering of the recommended dosage.

Dosage

Tirofiban is administered as an intravenous injection. 25 mcg/kg should be administered within the first five minutes. After this .15 mcg/kg should be administered every minute for a period of up to 18 hours in order to achieve the correct amount of anticoagulation. This dosage may be adjusted based on a patient's weight. The necessary amount of anticoagulation may be achieved at lower doses and at a shorter period of time. During the course of administration, the rate of coagulation will be monitored and the dosage of the drug will be adjusted as the conditions warrant.

In patients with renal problems, the dosage instructions differ. 25 mcg/kg should be administered within the first five minutes. However, the follow-on dosage should be .075 mcg/kg each minute for a period of up to 18 hours. As per regular dosage, this may be modified based on patient weight and the speed at which the drug produces the desired result.

Interactions

Tirofiban has potential interactions with a host of other medications. Over 200 drugs currently on the market are known to interact with tirofiban in some way. Nearly 50 of these drug interactions are considered major interactions. The drugs defibrotide and eptifibitide should not be used along with tirofiban.

The following is a list of some of the drugs that have been known to cause serious interactions with tirofiban:

  • Aceclofenac
  • Acemetacin
  • Alipogene Tiparvovec
  • Alteplase, Recombinant
  • Amtolmetin Guacil
  • Anagrelide
  • Apixaban
  • Ardeparin
  • Argatroban
  • Aspirin
  • Bemiparin
  • Bivalirudin
  • Bromfenac
  • Bufexamac
  • Celecoxib
  • Certoparin
  • Choline Salicylate
  • Cilostazol
  • Citalopram
  • Clonixin
  • Dabigatran Etexilate
  • Dalteparin
  • Danaparoid
  • Desirudin
  • Desvenlafaxine
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Droxicam
  • Duloxetine
  • Edoxaban
  • Enoxaparin
  • Escitalopram
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Fondaparinux
  • Heparin
  • Ibuprofen
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Lepirudin
  • Levomilnacipran
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Milnacipran
  • Morniflumate
  • Nabumetone
  • Nadroparin
  • Naproxen
  • Nefazodone
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Nimesulide Beta-Cyclodextrin
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Parnaparin
  • Paroxetine
  • Phenindione
  • Phenprocoumon
  • Phenylbutazone
  • Piketoprofen
  • Piracetam
  • Piroxicam
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Protein C
  • Reviparin
  • Rivaroxaban
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sodium Salicylate
  • Sulindac
  • Tenoxicam
  • Tiaprofenic Acid
  • Tinzaparin
  • Tolfenamic Acid
  • Tolmetin
  • Valdecoxib
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Warfarin

Taking Vitamin A while on tirofiban is not recommend. Vitamin K helps to clot the blood, so foods containing large amounts of Vitamin K such as kale, cabbage, Brussels sprouts, and broccoli should be avoided.

Warnings

Caution must be observed when taking this drug. Patients should support any adverse reactions or any abnormal bleeding to their physician as soon as possible. Some of the side effects of this drug may occur for up to several days after the drug is injected. After the patient returns home, care must be taken to avoid getting nicks or cuts that may bleed excessively. Patients should use an electric razor for shaving and should take care not to brush the gums too hard for a few days after tirofiban is discontinued.

If a patient notices small, bluish-red, pinprick marks on the arms and legs, this should be reported immediately. This is a potentially serious platelet abnormality that may be caused by the drug.

When the patient returns home s/he should note any blood in the urine or stool. This along with any other bleeding issue should be reported to the doctor right away.

Those who have reduced kidney functions should notify the doctor before this drug is used. Those with reduced kidney functions may need a different medication or a reduced dosage of tirofiban.

Those who have active bleeding in the body should not use this drug as excessive bleeding may result.

This drug should be used with caution in those patients who have had a major surgery within 30 days preceding tirofiban administration.

Do not stop or start any medication after receiving tirofiban without consulting a doctor or pharmacist. This includes non-prescription drugs and herbal and nutritional substances.

This drug is in Pregnancy Category B. Those mothers who are nursing when the drug is administered are advised to stop breastfeeding from this point or determine if another drug may be administered.

Care must be taken when this drug is administered to those who are over 65 years old. Some of the side effects that have been noted with the drug are at times more serious and more pronounced in those who are over the age of 65.

For a period of time after this drug has been administered, the doctor will want the patient to come in for blood tests to make sure that the body's natural clotting function has returned to normal.

Storage

This drug is stored on site in a hospital or healthcare facility. It is not stored by the patient nor administered by the patient.

Summary

Tirofiban is a drug that is used in a clinical setting for the purpose of preventing blood clots in patients with chest pain or who are experiencing a cardiovascular event such as a heart attack. The drug is also used to provide anticoagulation in the blood prior to catheters being inserted when angioplasty is performed or a cardiac stent is being placed.

This is a drug that has a number of known drug interactions. All medications that a patient is using need to be reported to the doctor before tirofiban is administered.

This medicine may produce a number of side effects. Most of the side effects center around excessive bleeding. This excessive bleeding may occur during the administration of the drug, or it may occur up to several days after the drug was administered.

Since this drug is administered in a hospital setting, the patient will be closely monitored for any potential side effects, and these will be managed and controlled as needed.

The patient will need to take precautions for a few days to avoid nicks and cuts that may cause bleeding.