Clinical beta

FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.

Drug Monograph

Tirofiban

Tirofiban

GP IIb/IIIa inhibitor (non-peptide)

PCIIVAdult

Indication

NSTE-ACS β€’ PCI when GPI on formulary

At a glance

INDICATIONS (CORE USE)

ACS / PCI β€” **renal dose** reduction; similar class bleed profile to eptifibatide.

ADULT DOSE (STANDARD)

Loading infusion then maintenance β€” **CrCl ≀60** halve maintenance per label

MAX DOSE

Per label

Route

IV

PEDIATRIC DOSE

Not used

Do not miss

Must-not-miss safety points

Major warning

- Bleeding - thrombocytopenia - hypotension

Indications

USE IF: ACS/PCI pathway. AVOID IF: Active internal bleeding, recent surgery, severe renal failure without dose adjustment per label.

Primary

  • NSTE-ACS
  • selected PCI

Dosing

STANDARD (ADULT PO)

0.4 mcg/kg/min Γ—30 min then 0.1 mcg/kg/min β€” reduce maintenance if CrCl ≀60

ADULT DOSE

Pharmacy dosing spreadsheet.

PEDIATRIC DOSE

N/A

MAX DOSE

Per label

Practical Note

Platelet count monitoring.

Warnings

Clinical warnings

  • **Major bleeding** (GI, ICH, post-procedural) β€” higher with **DAPT**, triple therapy, renal failure, age β€” counsel early symptoms
  • **Thrombocytopenia** on infusion β€” stop drug; **not** interchangeable monitoring vs oral agents
  • Thrombocytopenia

Adverse effects

  • Bleeding
  • bradycardia
  • thrombocytopenia

Contraindications

  • **Active major bleeding** β€” hold until controlled unless embedded in explicit procedural plan
  • **Recent major surgery / ICH** β€” generally **avoid** outside cath-lab ACS/PCI protocol
  • Active internal bleeding
  • CVA within 30 days or hemorrhagic CVA ever
  • major surgery <30d

Drug interactions

  • **Heparin/bivalirudin stack in lab** β†’ bleed surveillance per protocol; **any new antiplatelet** β†’ **reassess** β€” not outpatient casual add-on
  • Heparin
  • antiplatelets

Special populations

Pediatrics

Not used

Pregnancy

Avoid

Lactation

See lactation references and product labeling.

Renal impairment

**≀60 CrCl** β†’ reduce infusion rate per label

Hepatic impairment

Limited data

Elderly

Renal estimate

Administration

IV monitored setting

Monitoring

  • Monitor: - **Platelet count falls on infusion** β†’ **stop GPI** + hematology - **Access-site or systemic bleed** β†’ **stop infusion** + hemostasis; **abciximab** longer platelet-bound effect than small molecules - **Hypotension with bolus** β†’ slow per protocol - **Transition to oral DAPT** per cath lab β€” **no duplicate** GPI + outpatient antiplatelet stack - Platelets - hemoglobin if long infusion
  • Recheck: - New or worsening **bleeding**, unexplained **Hb drop**, or planned invasive procedure within **48–72h** β†’ reassess antiplatelet plan with cardiology/surgery when on DAPT - If targets not met after reassessment of dose, organ function, and interactions β†’ escalate per protocol (DO NOT continue blindly)

Overdose / toxicity

Clinical Picture

**A) Therapeutic complication:** **bleeding** during/after PCI or **thrombocytopenia** on infusion β€” dominant scenarios. **B) True β€œoverdose”** beyond protocol bolus: management is **stop infusion + supportive/bleed care** β€” **no** specific reversal antidote (unlike salicylate toxicology).

Immediate Actions

**A:** Stop infusion β†’ ABCs; **platelet count**; access-site + systemic hemostasis; platelet transfusion if **severe thrombocytopenia + active bleed** per hematology. **B:** Supportive; prolonged monitoring if massive bolus error β€” institution-specific

Antidote

No specific antidote; treat complications (supportive care, platelets / hemostasis per protocol, anaphylaxis β†’ epinephrine per ACLS)

Decontamination

N/A

Escalation

Refractory bleed or platelets **<20k** with hemorrhage β†’ **ICU** + hematology; **short TΒ½** (eptifibatide/tirofiban) vs **abciximab** longer platelet-bound effect

Clinical pearls

Common mistakes, resistance logic, and bedside traps

High-Yield Summary

**Renal infusion cut** at CrCl ≀60. β†’ Class bleed + platelet surveillance.

Clinical pearls

Institution may prefer eptifibatide vs tirofiban β€” same class teaching. *Antiplatelet (all agents):* **Primary vs secondary (aspirin):** primary **not routine**; secondary **strong** when guideline-supported. **DAPT:** **do not stop early** post-stent without expert; duration **ACS vs stable CAD**; procedures need **explicit review**. **Bleeding-first:** GI/ICH/peri-op; **duplicate/hidden aspirin** on med rec. **Aspirin toxicity** (salicylate) is a **separate pathway** from antiplatelet bleed.

Antiplatelet safety

  • CrCl dose
  • Platelet count
  • Access site

Pharmacokinetics

Renal clearance dominant; short duration after stop.

Mechanism of action

GP IIb/IIIa competitive antagonist.

Common brand names

Saudi Arabia

Aggrastat

Global

(placeholder β€” verify local product)

Common trade names are curated examples only β€” formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.

Country practice notes

  • DAPT duration and perioperative management follow **ESC/AHA/ACC** and local cardiology consensus β€” not one-size rules.
  • Primary prevention aspirin thresholds differ by guideline and age β€” verify regional primary-care policy.

References

Saudi Arabia

  • SFDA (Saudi Food & Drug Authority)
  • Saudi National Formulary / MOH (where available)

International

  • WHO Model List of Essential Medicines (verify current edition)
  • US FDA or EU EMA product information (when national SmPC is unavailable)
  • ACC / AHA / ESC cardiovascular guidelines (CAD, ACS, PCI)
  • FDA / SFDA product labeling
  • Local cath lab / antithrombotic protocol
  • ACC / AHA / ESC cardiovascular guidelines (CAD, ACS, PCI)
  • FDA / SFDA product labeling
  • Local cath lab / antithrombotic protocol

Do not miss

  • Document antiplatelet indication (primary vs secondary prevention vs stent DAPT)
  • Med reconciliation: OTC aspirin, NSAIDs, fish oil, anticoagulants
  • **Thrombocytopenia:** Acute drop on infusion β†’ **stop GPI** + hematology β€” can mimic HIT timing but pathway differs.
  • **Bleeding (access site / systemic / peri-PCI):** **Stop infusion** + hemostasis; **abciximab** longer platelet-bound effect than **eptifibatide/tirofiban** β€” procedural timing differs.
  • **Duplicate blockade:** GPI + DAPT + parenteral anticoagulant β†’ **maximal bleed** β€” protocol-driven only; **no casual addition** of NSAID/antiplatelet.
  • Forgot renal adjustment β†’ supratherapeutic bleed.
  • CrCl dose
  • Platelet count
  • Access site