tirofiban hydrochloride monohydrate: clinical use

Prescribing considerations

• Hospital-only treatment under specialists experienced in acute coronary syndrome management.
• Assess bleeding history, recent trauma or invasive procedures, cerebrovascular history, blood pressure, renal and liver function, body weight and medicines affecting haemostasis.
• Renal impairment reduces clearance and increases bleeding risk; use the product-specific renal adjustment and monitor closely.
• Older adults, women and people with lower body weight experienced more bleeding in clinical data.
• Minimise intramuscular injections and vascular punctures; use compressible access sites where possible and inspect them closely.

Contraindications and cautions

• Hypersensitivity to tirofiban or an excipient, or thrombocytopenia during previous glycoprotein IIb/IIIa antagonist exposure.
• Recent stroke or any previous haemorrhagic stroke; known intracranial tumour, aneurysm or arteriovenous malformation.
• Active or recent clinically relevant bleeding.
• Malignant hypertension.
• Recent major trauma or major surgery.
• Thrombocytopenia, platelet-function disorders or significant coagulation disturbance.
• Severe liver failure.

Monitoring

• Check platelet count, haemoglobin and haematocrit before and during treatment.
• Monitor for visible and occult bleeding, especially at vascular-access sites.
• Monitor renal function because reduced clearance increases exposure and bleeding risk.
• When unfractionated heparin is used, monitor its anticoagulant effect with appropriate coagulation testing.
• If thrombocytopenia develops, confirm the result, assess for bleeding and act promptly according to the product information.

Clinical pharmacology

Tirofiban is a reversible, non-peptide glycoprotein IIb/IIIa receptor antagonist. It is minimally metabolised and eliminated substantially through renal and biliary routes; reduced renal function lowers clearance. Its plasma half-life is short, and platelet function generally returns to baseline within several hours of stopping treatment.

Formulation and product differences

• The selected product is a clear, colourless, ready-to-use solution for intravenous infusion in a non-PVC infusion bag. It should not be confused with the concentrate formulation that requires dilution.
• The infusion solution contains a clinically relevant amount of sodium, which should be considered for people following a controlled-sodium diet.
• Inspect the solution and container before administration. Do not use if discoloured, particulate or leaking, and do not add supplementary medicines to the bag.

Solution for infusion

Route: Intravenous

Strengths: 50 micrograms/mL, 250 micrograms/mL