Version July 2025
Acute coronary syndrome:
Note: Routine antithrombotic therapy for patients undergoing percutaneous coronary intervention (PCI) includes oral antiplatelet therapy (eg, aspirin plus a P2Y12 inhibitor) and an IV anticoagulant (eg, heparin or bivalirudin). A glycoprotein IIb/IIIa inhibitor is not routinely used due to limited benefit on ischemic outcomes and more bleeding complications. However, use may be considered in high-risk patients (eg, significant thrombus burden) (Ref).
Non-ST elevation acute coronary syndromes: IV: Bolus of 180 mcg/kg (maximum: 22.6 mg) beginning after diagnostic coronary angiography, just before PCI, followed by a continuous infusion of 2 mcg/kg/minute (maximum: 15 mg/hour); a second bolus of 180 mcg/kg (maximum: 22.6 mg) should be administered 10 minutes after the first bolus; continue infusion for up to 18 to 24 hours after PCI (Ref).
ST elevation myocardial infarction (off-label use): IV: Bolus of 180 mcg/kg (maximum: 22.6 mg) beginning after diagnostic coronary angiography, just before PCI, followed by a continuous infusion of 2 mcg/kg/minute (maximum: 15 mg/hour); a second bolus of 180 mcg/kg (maximum: 22.6 mg) should be administered 10 minutes after the first bolus; continue infusion for up to 18 to 24 hours after PCI (Ref).
Percutaneous coronary intervention:
Note: Routine antithrombotic therapy for patients undergoing percutaneous coronary intervention (PCI) includes oral antiplatelet therapy (eg, aspirin plus a P2Y12 inhibitor) and an IV anticoagulant (eg, heparin or bivalirudin). A glycoprotein IIb/IIIa inhibitor is not routinely used due to limited benefit on ischemic outcomes and more bleeding complications (Ref).
IV: Bolus of 180 mcg/kg (maximum bolus: 22.6 mg) beginning after diagnostic coronary angiography, just before PCI, followed by a continuous infusion of 2 mcg/kg/minute (maximum: 15 mg/hour); a second bolus of 180 mcg/kg (maximum: 22.6 mg) should be administered 10 minutes after the first bolus; may administer continuous infusion for up to 18 to 24 hours after PCI or until hospital discharge, whichever comes first; alternatively, some administer the continuous infusion for only <2 hours after PCI (Ref).
Note: If coronary artery bypass graft surgery is performed, discontinue eptifibatide ≥4 hours before surgery (Ref); pharmacokinetic studies indicate that platelet function is restored ~4 to 8 hours after discontinuation (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Note: The Cockcroft-Gault equation using actual body weight should be used to estimate renal function.
CrCl ≥50 mL/minute: No dosage adjustment necessary.
CrCl <50 mL/minute: IV: Bolus of 180 mcg/kg (maximum: 22.6 mg) beginning after diagnostic coronary angiography, just before percutaneous coronary intervention (PCI), followed by a continuous infusion of 1 mcg/kg/minute (maximum: 7.5 mg/hour); a second bolus of 180 mcg/kg (maximum: 22.6 mg) should be administered 10 minutes after the first bolus; continue infusion for up to 18 to 24 hours after PCI.
End-stage renal disease (ie, dialysis dependent): Use is contraindicated.
Hemodialysis: Dialyzable: Yes; ~73 to 83% removed after 1 hour (Ref).
There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).
Refer to adult dosing. No dosing adjustment for the elderly appears to be necessary; adjust carefully to renal function.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not always defined. Bleeding is the major drug-related adverse effect. Access site is often primary source of bleeding complications. Incidence of bleeding is also related to heparin intensity. Patients weighing <70 kg may have an increased risk of major bleeding.
>10%: Hematologic: & oncologic: Hemorrhage (major: 1% to 11%; minor: 3% to 14%; transfusion required: 2% to 13%)
1% to 10%:
Cardiovascular: Hypotension (≤7%)
Hematologic & oncologic: Thrombocytopenia (1% to 3%; includes acute profound thrombocytopenia, immune-mediated thrombocytopenia)
Local: Injection site reaction
<1%, postmarketing and/or case reports: Anaphylaxis, cerebrovascular accident, gastrointestinal hemorrhage, intracranial hemorrhage, pulmonary hemorrhage
Hypersensitivity to eptifibatide or any component of the formulation; active abnormal bleeding within the previous 30 days or a history of bleeding diathesis; history of stroke within 30 days or a history of hemorrhagic stroke; severe hypertension (systolic blood pressure >200 mm Hg or diastolic blood pressure >110 mm Hg) not adequately controlled on antihypertensive therapy; major surgery within the preceding 6 weeks; current or planned administration of another parenteral GP IIb/IIIa inhibitor; dependency on hemodialysis
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Canadian labeling: Additional contraindications (not in US labeling): PT >1.2 times control or INR ≥2.0; known history of intracranial disease (eg, neoplasm, arteriovenous malformation, aneurysm); severe renal impairment (CrCl <30 mL/minute); thrombocytopenia (<100,000 cells/mm3); clinically significant liver disease
Concerns related to adverse effects:
• Bleeding: The most common complication is bleeding, including retroperitoneal, pulmonary, and spontaneous GI and/or GU bleeding; monitor closely for bleeding, especially the arterial access site for the cardiac catheterization. Risk factors for bleeding include older age, a history of bleeding disorders, and concomitant use of drugs that increase the risk of bleeding (thrombolytics, oral anticoagulants, NSAIDs, and/or P2Y12 inhibitors). Patients <70 kg may be at greater risk for major and minor bleeding. Minimize invasive procedures, including arterial and venous punctures, IM injections, and the use of urinary catheters, nasotracheal intubation and nasogastric tubes.
• Hypersensitivity: Hypersensitivity reactions have occurred, including anaphylaxis and urticaria.
• Thrombocytopenia: Acute, profound thrombocytopenia (immune-mediated and nonimmune mediated) has occurred and may occur within 24 hours of initiation (Cheema 2006; Coons 2005; Nagge 2003; Rezkalla 2003; Salengro 2003). Platelet counts should recover rapidly (within 1-5 days) after discontinuation. Use with extreme caution in patients with platelet counts <100,000/mm3 (contraindicated in the Canadian labeling). If platelet count decreases to <100,000/mm3 during therapy, discontinue eptifibatide and heparin if administered concurrently. Specific management guidelines for GP IIb/IIIa induced thrombocytopenia have been published (Huxtable 2006; Llevadot 2000).
Disease-related concerns:
• Renal impairment: Use with caution in patients with renal dysfunction (estimated CrCl <50 mL/minute, using Cockcroft-Gault equation); dosage adjustment required. Use is contraindicated in patients dependent upon hemodialysis.
Other warnings/precautions:
• Sheath removal: Prior to pulling the sheath after percutaneous coronary intervention (PCI), heparin should be discontinued for 3 to 4 hours and ACT should be <180 seconds or aPTT <50 seconds. Of note, full dose anticoagulation is no longer used after successful PCI procedures. Use standard compression techniques after sheath removal. Monitor the site closely afterwards for further bleeding.
• Surgery: Discontinue ≥4 hours prior to coronary artery bypass graft surgery (ACC/AHA [Lawton 2022]).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous:
Integrilin: 20 mg/10 mL (10 mL [DSC])
Generic: 75 mg/100 mL (100 mL); 20 mg/10 mL (10 mL)
Solution, Intravenous [preservative free]:
Generic: 75 mg/100 mL (100 mL); 20 mg/10 mL (10 mL); 200 mg/100 mL (100 mL)
Yes
Solution (Eptifibatide Intravenous)
20 mg/10 mL (per mL): $3.60 - $15.22
75 mg/100 mL (per mL): $1.08 - $4.69
200 mg/100 mL (per mL): $4.80 - $6.00
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous:
Integrilin: 75 mg/100 mL ([DSC]); 20 mg/10 mL ([DSC])
Generic: 75 mg/100 mL (100 mL); 20 mg/10 mL (10 mL)
IV:
Bolus dose: Withdraw the dose from the 10 mL vial into a syringe and administer by IV push.
Continuous infusion: Use the 100 mL vial or premixed container. Begin the continuous infusion using an IV infusion pump immediately following bolus administration.
100 mL vial: Spike vial with a vented infusion set and administer undiluted directly from the vial.
100 mL premixed container: Administer undiluted directly from the container.
Percutaneous coronary intervention: Treatment of patients undergoing percutaneous coronary intervention, including those undergoing intracoronary stenting.
Non-ST elevation acute coronary syndromes: Treatment of patients with unstable angina or non–ST-segment elevation myocardial infarction, primarily for patients undergoing percutaneous coronary intervention.
ST-elevation myocardial infarction
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (glycoprotein IIb/IIIa inhibitor) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care Settings).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Abrocitinib: Therapeutic Antiplatelets may increase antiplatelet effects of Abrocitinib. Management: Do not use antiplatelet drugs with abrocitinib during the first 3 months of abrocitinib therapy. The abrocitinib prescribing information lists this combination as contraindicated. This does not apply to low dose aspirin (81 mg/day or less). Risk X: Avoid
Acalabrutinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Aducanumab: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Agents with Antiplatelet Effects: May increase antiplatelet effects of Glycoprotein IIb/IIIa Inhibitors. Risk C: Monitor
Anagrelide: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Anticoagulants (Miscellaneous Agents): Therapeutic Antiplatelets may increase anticoagulant effects of Anticoagulants (Miscellaneous Agents). Risk C: Monitor
Antiplatelet Agents (P2Y12 Inhibitors): Therapeutic Antiplatelets may increase antiplatelet effects of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor
Caplacizumab: May increase antiplatelet effects of Therapeutic Antiplatelets. Management: Avoid this combination if possible. If coadministration is required, monitor closely for bleeding. Interrupt caplacizumab if clinically significant bleeding occurs and administer von Willebrand factor concentrate to rapidly correct hemostasis, if needed. Risk D: Consider Therapy Modification
Collagenase (Systemic): Therapeutic Antiplatelets may increase adverse/toxic effects of Collagenase (Systemic). Specifically, the risk of injection site bruising and or bleeding may be increased. Risk C: Monitor
Dasatinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Deoxycholic Acid: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Desirudin: Therapeutic Antiplatelets may increase anticoagulant effects of Desirudin. Risk C: Monitor
Direct Oral Anticoagulants (DOACs): Glycoprotein IIb/IIIa Inhibitors may increase anticoagulant effects of Direct Oral Anticoagulants (DOACs). Risk C: Monitor
Donanemab: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Fondaparinux: Glycoprotein IIb/IIIa Inhibitors may increase anticoagulant effects of Fondaparinux. Management: Discontinue antiplatelet agents, such as glycoprotein IIb/IIIa inhibitors, prior to fondaparinux therapy, if possible. If co-administration is required, use caution and monitor patients closely for signs and symptoms of bleeding. Risk D: Consider Therapy Modification
Glycoprotein IIb/IIIa Inhibitors: Therapeutic Antiplatelets may increase anticoagulant effects of Glycoprotein IIb/IIIa Inhibitors. Risk C: Monitor
Heparin: Glycoprotein IIb/IIIa Inhibitors may increase anticoagulant effects of Heparin. Risk C: Monitor
Heparins (Low Molecular Weight): Glycoprotein IIb/IIIa Inhibitors may increase anticoagulant effects of Heparins (Low Molecular Weight). Risk C: Monitor
Herbal Products with Anticoagulant/Antiplatelet Effects: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Ibritumomab Tiuxetan: Therapeutic Antiplatelets may increase antiplatelet effects of Ibritumomab Tiuxetan. Risk C: Monitor
Ibrutinib: Therapeutic Antiplatelets may increase adverse/toxic effects of Ibrutinib. Specifically, the risks of bleeding and hemorrhage may be increased. Risk C: Monitor
Icosapent Ethyl: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Inotersen: Therapeutic Antiplatelets may increase adverse/toxic effects of Inotersen. Specifically, the risk of bleeding may be increased. Risk C: Monitor
Lecanemab: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Limaprost: May increase adverse/toxic effects of Therapeutic Antiplatelets. Specifically, the risk of bleeding may be increased. Risk C: Monitor
Lipid Emulsion (Fish Oil Based): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Miscellaneous Antiplatelets: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Multivitamins/Fluoride (with ADE): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Multivitamins/Minerals (with ADEK, Folate, Iron): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Multivitamins/Minerals (with AE, No Iron): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Obinutuzumab: Therapeutic Antiplatelets may increase adverse/toxic effects of Obinutuzumab. Specifically, the risk of bleeding may be increased. Management: Consider avoiding coadministration of obinutuzumab and therapeutic antiplatelets, especially during the first cycle of obinutuzumab therapy. Risk D: Consider Therapy Modification
Omega-3 Fatty Acids: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Pentosan Polysulfate Sodium: Therapeutic Antiplatelets may increase adverse/toxic effects of Pentosan Polysulfate Sodium. Specifically, the risk of hemorrhage may be increased. Risk C: Monitor
Pirtobrutinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Selumetinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Therapeutic Antiplatelets: May increase anticoagulant effects of Glycoprotein IIb/IIIa Inhibitors. Risk C: Monitor
Thrombolytic Agents: Therapeutic Antiplatelets may increase adverse/toxic effects of Thrombolytic Agents. Specifically, the risk of bleeding may be increased. Risk C: Monitor
Tipranavir: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Vitamin E (Systemic): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Vitamin K Antagonists: Glycoprotein IIb/IIIa Inhibitors may increase anticoagulant effects of Vitamin K Antagonists. Risk C: Monitor
Volanesorsen: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Zanubrutinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Information related to eptifibatide use in pregnancy is limited (Al-Aqeedi 2008; Bauer 2012; Serna Candel 2019). Myocardial infarction is a medical emergency; maternal treatment should not be withheld because of fears of teratogenicity.
It is not known if eptifibatide is present in breast milk.
If present in breast milk, eptifibatide is expected to be destroyed in the infant GI tract and not be orally absorbed via breastfeeding.
Coagulation parameters, signs/symptoms of excessive bleeding. Laboratory tests at baseline and monitoring during therapy: hematocrit and hemoglobin, serum creatinine, PT/aPTT (maintain aPTT between 50-70 seconds unless PCI is to be performed), and ACT with PCI (maintain ACT between 200-300 seconds during PCI). Platelet count recommended at 2-4 hours after initiation, and at 24 hours or prior to discharge, whichever is first.
Assess sheath insertion site and distal pulses of affected leg every 15 minutes for the first hour and then every 1 hour for the next 6 hours. Arterial access site care is important to prevent bleeding. Care should be taken when attempting vascular access that only the anterior wall of the femoral artery is punctured, avoiding a Seldinger (through and through) technique for obtaining sheath access. Femoral vein sheath placement should be avoided unless needed. While the vascular sheath is in place, patients should be maintained on complete bedrest with the head of the bed at a 30° angle and the affected limb restrained in a straight position.
Observe patient for mental status changes, hemorrhage, assess nose and mouth mucous membranes, puncture sites for oozing, ecchymosis and hematoma formation, and examine urine, stool and emesis for presence of occult or frank blood; gentle care should be provided when removing dressings.
Eptifibatide is a cyclic heptapeptide which blocks the platelet glycoprotein IIb/IIIa receptor, the binding site for fibrinogen, von Willebrand factor, and other ligands. Inhibition of binding at this final common receptor reversibly blocks platelet aggregation and prevents thrombosis.
Onset of action: Immediate after initial bolus (>80% inhibition of ADP-induced aggregation achieved 5 minutes after bolus dose); maximal effect achieved within 1 hour (Gilchrist, 2001; Tardiff, 2001)
Duration: Platelet function restored ~4 to 8 hours following discontinuation (Tardiff, 2001)
Protein binding: ~25%
Half-life elimination: ~2.5 hours
Excretion: Primarily urine (as eptifibatide and metabolites)
Clearance: Total body: ~55 mL/kg/hour; Renal: ~50% of total body clearance in healthy subjects
Altered kidney function: Clearance reduced approximately 50% and steady-state plasma levels are approximately doubled in patients with moderate to severe renal function impairment (CrCl less than 50 mL/minute).
Older adult: Higher plasma levels and lower total body clearance.
