Abciximab

Indications

Abciximab is used for: Unstable Angina, Adjunct to PCI

Adult Dose

Intravenous 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

Child Dose

Renal Dose

Renal impairment: Severe (requiring haemodialysis): Contraindicated.

Administration

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

Contra Indications

Because Abciximab may increase the risk of bleeding, Abciximab is contraindicated in the following clinical situations: • Active internal bleeding • Recent (within six weeks) gastrointestinal (GI) or genitourinary (GU) bleeding of clinical significance • History of cerebrovascular accident (CVA) within two years, or CVA with a significant residual neurological deficit • Bleeding diathesis • Administration of oral anticoagulants within seven days unless prothrombin time is< 1.2 times control • Thrombocytopenia (< 100,000 cells/µL) • Recent (within six weeks) major surgery or trauma • Intracranial neoplasm, arteriovenous malformation, or aneurysm • Severe uncontrolled hypertension • Presumed or documented history of vasculitis • Use of intravenous dextran before PCI, or intent to use it during an intervention Abciximab is also contraindicated in patients with known hypersensitivity to any component of this product or to murine proteins.

Precautions

Intended for use with aspirin and heparin, and has only been studied in that setting Allergic reactions, some of which were anaphylaxis (sometimes fatal), reported rarely in patients receiving therapy; patients with allergic reactions should receive appropriate treatment; treatment of anaphylaxis should include immediate discontinuation of therapy and initiation of resuscitative measures In the event of serious uncontrolled bleeding or need for emergency surgery, therapy should be discontinued; if platelet function does not return to normal, it may be restored, at least in part, with platelet transfusions Bleeding events Has the potential to increase risk of bleeding events, rarely including those with a fatal outcome, particularly in presence of anticoagulation, eg, from heparin, other anticoagulants, or thrombolytics Risk of major bleeds due to therapy is increased in patients receiving thrombolytics and should be weighed against anticipated benefits Should serious bleeding occur that is not controllable with pressure, the infusion of this medication and any concomitant heparin should be stopped Use of thrombolytics, anticoagulants, and other antiplatelet agents Because drug inhibits platelet aggregation, caution should be employed when it is used with other drugs that affect hemostasis, including thrombolytics, oral anticoagulants, non-steroidal anti-inflammatory drugs, dipyridamole, and ticlopidine Because of observed synergistic effects on bleeding, therapy should be used judiciously in patients who have received systemic thrombolytic therapy Monitoring Parameter Monitor platelet counts prior to, during, and after treatment Before infusion of Abciximab, prothrombin time, ACT, APTT, and platelet count should be measured to identify pre-existing hemostatic abnormalities.

Pregnancy-Lactation

Pregnancy Category: C Lactation: not known if excreted in breast milk; use caution

Interactions

Formal drug interaction studies with Abciximab have not been conducted. Abciximab has been administered to patients with ischemic heart disease treated concomitantly with a broad range of medications used in the treatment of angina, myocardial infarction and hypertension. These medications have included heparin, warfarin, beta-adrenergic receptor blockers, calcium channel antagonists, angiotensin converting enzyme inhibitors, intravenous and oral nitrates, ticlopidine, and aspirin. Heparin, other anticoagulants, thrombolytics, and antiplatelet agents are associated with an increase in bleeding. Patients with HACA titers may have allergic or hypersensitivity reactions when treated with other diagnostic or therapeutic monoclonal antibodies. Potentially Fatal: Major bleeding episodes may occur w/ concomitant oral anticoagulants or IV admin of dextran. Contraindicated (1) abrocitinib Serious - Use Alternative (14) antithrombin alfa antithrombin III apixaban argatroban aspirin rectal bemiparin bivalirudin caplacizumab dalteparin enoxaparin fondaparinux heparin phenindione protamine

Adverse Effects

Side effects of Abciximab : >10% Bleeding, minor (70-82%) Bleeding, major (17-21%) Hypotension (14-21%) Back pain (17.6%) Nausea (13.6%) Chest pain (11.4%) Vomiting (7-11%) 1-10% Headache (6%) Thrombocytopenia (2-6%) Bradycardia (5%) Injection site pain (3.6%) Extremity pain (3.5%) Abdominal pain (3%) UTI (2%) Dizziness (1.8%) Peripheral edema (1.6%) Anemia (1.2%) Diarrhea (1%) Hypoesthesia (1%)

Mechanism of Action

Abciximab is the Fab fragment of the chimeric monoclonal antibody 7E3 which binds to glycoprotein (GP) IIb or IIIa receptor on platelet surface, thus preventing binding of fibrinogen, von Willebrand factor, and other adhesive molecules to the receptor sites, leading to inhibition of platelet aggregation.