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Updated 2 Feb 2023 | Other antiplatelet drugs


Solution for infusion containing 75mg eptifibatide in 100ml.
Solution for injection containing 20mg eptifibatide in 10ml.

Drugs List

  • eptifibatide 20mg/10ml injection
  • eptifibatide 75mg/100ml infusion
  • INTEGRILIN 20mg/10ml injection
  • INTEGRILIN 75mg/100ml infusion
  • Therapeutic Indications


    To be used in conjunction with aspirin and unfractionated heparin for:

    Prevention of early myocardial infarction in patients presenting with unstable angina or non-Q-wave myocardial infarction, with the last episode of chest pain occurring within 24 hours and with ECG changes and/or elevated cardiac enzymes.

    Patients likely to benefit most from this treatment are those at high risk of developing myocardial infarction within the first 3-4 days after the onset of acute angina symptoms (e.g. those likely to undergo an early PTCA).


    Treatment should be initiated in hospital by a specialist, as soon as possible after diagnosis.

    Eptifibatide is intended for use with aspirin and unfractionated heparin unless contraindicated.

    Eptifibatide infusion must be used in conjunction with eptifibatide injection.


    Initial dose: Intravenous bolus of 180micrograms/kg as soon as possible after diagnosis.
    Maintenance dose: A continuous infusion of 2micrograms/kg/minute for up to 72 hours, until initiation of coronary artery bypass (CABG) surgery, or discharge from the hospital (whichever occurs first).

    Percutaneous Coronary Intervention (PCI)
    If PCI is performed during eptifibatide therapy, continue the infusion for 20 to 24 hours post-PCI for an overall maximum duration of therapy of 96 hours.

    Emergency or semi-elective surgery
    If the patient requires emergency or urgent cardiac surgery during eptifibatide therapy, terminate infusion immediately. If semi-elective surgery is required, stop the infusion at a time appropriate to allow platelet function to return towards normal.


    Not recommended for use in patients under 18 years old.

    Patients with Renal Impairment

    Moderate renal impairment (creatinine clearance 30ml/minute to 50ml/minute)
    Initial dose: Intravenous bolus of 180micrograms/kg as soon as possible after diagnosis.
    Maintenance dose: A continuous infusion of 1microgram/kg/minute for the remainder of the duration of therapy.

    Severe renal impairment (creatinine clearance below 30ml/minute)

    The Renal Drug Handbook suggests that for patients with a glomerular filtration rate below 50ml/minute the infusion should be reduced to 1microgram/kg/minute and used with caution due to limited experience.

    Patients with Hepatic Impairment

    Experience is limited in these patients. Administer with caution in patients in whom coagulation could be affected.

    Contraindicated in clinically significant hepatic impairment - increased risk of bleeding.

    Additional Dosage Information

    Heparin dosage

    The manufacturer of eptifibatide recommends the following doses for heparin unless contraindicated:

    For unstable angina/ non-Q wave myocardial infarction:

    Patients weighing 70kg and over
    Initial dose: Intravenous bolus of 5,000units.
    Maintenance dose: A continuous intravenous infusion 1,000units/hour.

    Patients weighing less than 70kg
    Initial dose: Intravenous bolus of 60units/kg.
    Maintenance dose: 12units/kg/hour continuous intravenous infusion.

    The activated partial thromboplastin time (aPTT) must be monitored in order to maintain a value between 50 and 70 seconds, above 70 seconds there may be an increased risk of bleeding.

    If PCI is to be performed in the setting of unstable angina/non-Q wave myocardial infarction

    Monitor the activated clotting time(ACT) to maintain a value between 300 to 350 seconds. Stop heparin administration if the ACT exceeds 300 seconds; do not administer until the ACT falls below 300 seconds.

    See product literature to verify doses of heparin.

    There is no experience with eptifibatide and low molecular weight heparin.


    For intravenous administration.

    Inspect vial contents before use. If particulate matter or discolouration is present, discard vial.


    Eptifibatide may be administered through an intravenous line with the following medicinal products:
    Atropine sulfate
    Glyceryl trinitrate
    Tissue plasminogen activator
    0.9% sodium chloride solution for infusion
    Dextrose 5% in Normasol R (with/without potassium chloride)


    Eptifibatide is not compatible with furosemide.

    Do not mix this product with any medicinal product other than those mentioned in the compatibilities section.


    Abnormal bleeding within 30 days
    History of haemorrhagic stroke
    Stroke within 30 days
    History of intracranial disease e.g. neoplasm, arteriovenous malformation or aneurysm
    Major surgery or severe trauma within past 6 weeks
    Bleeding diathesis
    Thrombocytopenia (below 100,000 cells/cubic millimetre)
    Raised prothrombin times (greater than 1.2 times control or INR greater than or equal to 2)
    Severe hypertension (systolic blood pressure greater than 200mmHg or diastolic blood pressure greater than 110 mmHg on antihypertensive therapy)
    Severe renal impairment (creatinine clearance below 30ml/minute)
    Severe hepatic impairment
    Renal dialysis
    Breastfeeding (see Lactation section)
    Children under 18 years

    Precautions and Warnings

    Treatment should be initiated and supervised in hospital by a specialist.

    Hepatic impairment: see Dosage, Hepatic Impairment.

    Pregnancy - see Pregnancy section.

    Increased risk of bleeding. Monitor carefully, especially in the following patients:
    Patients with low body weight
    Moderate renal impairment (creatinine clearance 30-50ml/minute) - see Dosage Renal Impairment.
    Monitor potential bleeding sites e.g. catheter insertion sites, needle puncture, cutdown sites, gastrointestinal/genitourinary tracts, central and peripheral nervous system and retroperitoneal sites.

    An increased risk of bleeding may also be observed in patients who receive early administration of eptifibatide ( e.g. upon diagnosis) compared to receiving it immediately prior to PCI.

    Caution when puncturing the femoral artery. Arterial sheaths may be removed when coagulation returns to normal. Careful haemostasis must be ensured under close supervision after removal of the introducer sheath.

    Monitor haematological parameters (prothrombin time (PT), activated partial prothrombin time (aPTT), serum creatinine, platelet count, haemoglobin and haematocrit levels) prior to treatment. Haemoglobin, haematocrit and platelet count should then be monitored within six hours of administration and at least once daily thereafter while on therapy (or more often if there is evidence of a marked decrease).

    Eptifibatide inhibits platelet aggregation, but does not appear to affect viability of the platelets. Thrombocytopenia has been observed with eptifibatide use. The mechanism, whether immune and /or non immune mediated, by which eptifibatide may induce thrombocytopenia is not fully understood. However, treatment with eptifibatide was associated with antibodies that recognise GPIIb/IIIa occupied by eptifibatide, suggesting an immune mediated mechanism. Thrombocytopenia occurring after the first exposure to a GPIIb/IIIa inhibitor may be explained by the fact that antibodies are naturally present in some normal individuals.

    Since either repeat exposure with any GPIIb/IIIa ligand mimetic agent (e.g. abciximab or eptifibatide) or first time exposure to a GPIIb/IIIa inhibitor may be associated with immune mediated thrombocytopenic responses, monitoring is required, i.e. platelet counts should be monitored prior to treatment, within 6 hours of administration and at least once daily thereafter while on therapy and immediately at clinical signs of unexpected bleeding tendency.

    If either a confirmed platelet decrease to below 100,000 per cubic millimetre or acute profound thrombocytopenia is observed, discontinuation of each treatment medication having known or suspected thrombocytopenic effects, including eptifibatide, heparin, clopidogrel, should be considered immediately. The decision to use platelet transfusions should be based upon clinical judgement on an individual basis.

    In patients with previous immune mediated thrombocytopenia from other parenteral GPIIb/IIIa inhibitors, there are no data for the use of eptifibatide. Therefore it is not recommended to administer eptifibatide in patients who have previously experienced immune mediated thrombocytopenia with GPIIb/IIIa inhibitors including eptifibatide.

    Discontinue if circumstances arise that require thrombolytic therapy, emergency CABG or intra-aortic balloon pump.

    Discontinue eptifibatide and any concurrent heparin if severe haemorrhage occurs which is not controllable with pressure.

    Heparin administration is recommended unless a contraindication is present (see Additional Dosage section and product information for heparin) .

    Monitor activated clotting time (ACT) in percutaneous coronary intervention (PCI) to maintain a value between 300 to 350 seconds. Discontinue heparin if activated clotting time (ACT) exceeds 300 seconds. Do not administer eptifibatide until the ACT falls below 300 seconds.

    Not recommended for use in acute transmural myocardial infarction with new pathological Q waves or elevated ST-segments or left bundle branch block in ECG. There is a lack of experience in these patients.

    Pregnancy and Lactation


    There are no adequate data from the use of eptifibatide in pregnant women.

    Animal studies are insufficient with respect to effects on pregnancy, embryonal or foetal development, parturition or post natal development. The primary risk appears to be from maternal haemorrhage during administration. Eptifibatide should not be used during human pregnancy unless clearly necessary.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Licensed in pregnancy? - No

    Recommended for use in pregnancy? - No


    There is limited data on use during breastfeeding due to the indication for eptifibatide. It is unknown whether eptifibatide is excreted in human milk, however the molecular weight (about 832) and the potentially long intravenous infusions of the drug suggest that some eptifibatide will be excreted into the breast milk. The effect of this exposure on a nursing infant is unknown, but Briggs (2011) concludes that the risk is very low or nil because the drug should be digested in the infants gastrointestinal tract. Until more safety data is available, it is recommended that interruption of breastfeeding during treatment with eptifibatide should occur.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Considered suitable or recommended by manufacturer? - No.

    Drug substance licensed in infants? - No.

    Side Effects

    Cerebral ischaemia
    Anaphylactic reaction
    Atrial fibrillation
    Congestive cardiac failure
    Cardiac arrest
    Atrioventricular block
    Ventricular fibrillation
    Ventricular tachycardia
    Decrease in haemoglobin
    Decrease in haematocrit


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Shelf Life and Storage

    Store at 2 to 8 degrees C
    Store in original packaging (protected from light)

    Discard unused portion after opening.

    Further Information

    Last Full Review Date: April 2012

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

    Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics: Eptifibatide Accord 2 mg/ml solution for injection. Accord Healthcare Limited. Revised January 2016.
    Summary of Product Characteristics: Eptifibatide Accord 0.75 mg/ml solution for infusion. Accord Healthcare Limited. Revised January 2016.
    Summary of Product Characteristics: Integrilin 2mg solution for injection, 0.75mg solution for infusion. GlaxoSmithKline. Revised March 2012.

    The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.

    NICE Evidence Services Available at: Last accessed: 29 September 2017

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