Abciximab

Name: Abciximab

Advice to Patients

  • Risk of serious bleeding or hemorrhage.1 4 5 9

  • Importance of close laboratory monitoring.1

  • Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses (e.g., cardiovascular disease).1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of advising patients of other important precautionary information.1 (See Cautions.)

Pharmacology

Fab antibody fragment of the chimeric human-murine monoclonal antibody 7E3; this agent binds to platelet IIb/IIIa receptors, resulting in steric hindrance, thus inhibiting platelet aggregation

Distribution

Vd: 0.07 L/kg (Schror 2003)

Metabolism

Unbound abciximab metabolized via proteolytic cleavage (Schror 2003)

Onset of Action

Rapid; platelet aggregation reduced to <20% of baseline at 10 minutes

Time to Peak

Platelet inhibition: ~30 minutes (Mascelli 1998)

Dosing Geriatric

Refer to adult dosing.

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.

Warnings

Bleeding Events

Abciximab has the potential to increase the risk of bleeding events, rarely including those with a fatal outcome, particularly in the presence of anticoagulation, e.g., from heparin, other anticoagulants, or thrombolytics (see ADVERSE REACTIONS: Bleeding).

The risk of major bleeds due to Abciximab therapy is increased in patients receiving thrombolytics and should be weighed against the anticipated benefits.

Should serious bleeding occur that is not controllable with pressure, the infusion of Abciximab and any concomitant heparin should be stopped.

Allergic Reactions (including anaphylaxis)

Allergic reactions, some of which were anaphylaxis (sometimes fatal), have been reported rarely in patients treated with ReoPro. Patients with allergic reactions should receive appropriate treatment. Treatment of anaphylaxis should include immediate discontinuation of ReoPro administration and initiation of resuscitative measures.

Uses of Abciximab

Abciximab is a prescription medication used to prevent blood clots from forming during a percutaneous coronary intervention (PCI). This is a procedure done to open narrowed or blocked blood vessels that supply blood to the heart.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Abciximab Brand Names

Abciximab may be found in some form under the following brand names:

  • ReoPro

Dosing & Uses

Dosage Forms & Strengths

injectable solution

  • 2mg/mL

Adjunct to PCI

Prevention of cardiac ischemic complications in patients undergoing PCI

0.25 mg/kg IV bolus over at least 1 min, 10-60 min before start of PCI, THEN

0.125 mcg/kg/min IV continuous infusion for 12 hr; not to exceed infusion rate of 10 mcg/min 

Unstable Angina

Indicated for prevention of cardiac complications in patients with unstable angina with PCI planned within 24 hr

0.25 mg/kg IV bolus over at least 1 minute, THEN

0.125 mcg/kg/min IV continiuous infusion for 18-24 hr concluding 1 hour post-PCI; not to exceed 10 mcg/min  

Stop continuous infusion of abciximab in patients with failed PCIs

Other Indications & Uses

Adjunctive therapy during thrombolysis (off-label)

Safety and efficacy not established

Administration

IV Compatibilities

Solution: D5W, NS

Y-site: adenosine, atropine, bivalirudin, diphenhydramine, fentanyl, metoprolol, midazolam

IV Preparation

Do not add any other drugs in same IV line

Bolus injection: withdraw through 0.22 micron filter

Infusion: withdraw 4.5 mL (9 mg) through filter into syringe; inject into 250 mL of NS or D5W; final concentration 35 mcg/mL

Do not shake vial

IV Administration

Bolus over at least 1 min

See adult dosing for infusion rate

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