NAME OF DRUG
abciximab

CLASSIFICATION

antiplatelet antibody (GP IIb/IIIa receptor antagonist)

ALTERNATE NAMES

REOPRO

INDICATIONS

• an adjunct to percutaneous transluminal coronary angioplasty (PTCA) for the prevention of acute ischemic cardiac complications in patients at high risk for abrupt closure of the treated coronary vessel.

RECONSTITUTION AND STABILITY

• refrigerate ampoule; protect from freezing; do not shake ampoule
• bolus and infusion doses should be withdrawn into a syringe using a 0.2 or 0.22um filter; continuous infusions should be administered with an in-line 0.2 or 0.22 um filter, if not filtered during preparation
• infusion solution stable for 12 hours at room temperature
• discard unused portion of vial or infusion bag
• discard if particulate matter or solution is opaque

COMPATIBILITY

• compatible with NS, D5W
• compatible via Y-site with alteplase, digoxin, dobutamine, dopamine, epinephrine, heparin, morphine, lidocaine, nitroglycerin, nitroprusside, norepinephrine, propranolol, streptokinase, verapamil
• do not mix with other medications; administer via a separate IV line whenever possible

ROUTES OF ADMINISTRATION

• IV direct - undiluted over one minute
• IV infusion - dilute 9mg (4.5mL) in 250mL IV solution to provide a concentration of 36 mcg/mL

VH & HSC ADMINISTRATION POLICY

Restricted to Critical Care Areas

B - Direct IV restricted to nurses in Critical Care Areas

H - The IV infusion administration must be controlled by an automated infusion control device

DOSAGE

Bolus dose: 0.25 mg/kg IV over one minute given 10-60 minutes prior to PTCA

Maintenance dose: Follow bolus dose with continuous IV infusion of 10 mcg/minute (=17mL/hour) for 12 hours.

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• hypersensitivity reactions including anaphylaxis and fever

IMPORTANT IMPLICATIONS

• adverse effects include haemorrhage and acute profound thrombocytopenia. Check CBC with platelets at baseline and 4 and 24 hours following bolus dose. As well baseline aPTT and INR should be determined. If platelet count drops below 100 x A⁹/L, discontinue abciximab. Discontinue heparin and aspirin if platelet count drops below 60 x A⁹/L. Platelet transfusion may be required if platelet count drops below 50 x A⁹/L.
• maintain bleeding precautions (ie. avoid unnecessary arterial and venous punctures, no IM injections, avoid automatic blood pressure cuffs)
• contraindicated in patients with active bleeding, recent (within 6 weeks) history of GI or GU bleeding, recent major surgery or trauma, thrombocytopenia, intracranial neoplasm or AV malformation or aneurysm, severe uncontrolled hypertension, history of CVA within 2 years, vasculitis, known bleeding diatheses, use of IV dextran pre-PTCA or intent to use it during PTCA, or elevated baseline INR
• contraindicated if known hypersensitivity to abciximab or murine monoclonal antibodies
• readministration of abciximab may result in allergic or hypersensitivity reactions (including anaphylaxis), thrombocytopenia or decreased efficacy; although not a contraindication, caution is advised (crash cart should be readily available)

Rev. Oct 2007