Tirofiban (Aggrastat)
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   Tirofiban (Aggrastat) is a nonpeptide inhibitor of platelet aggregation
which prevents binding to the IlB/IIIA receptor. Tirofiban is approved for use
with heparin for treatment of unstable angina. It can be used in those
patients who receive medical treatment alone, as well as those undergoing PTCA
or atherectomy. The results of clinical trials show that there is a
significant benefit in patients with unstable angina/non Q-wave infarction
treated with tirofiban as compared to standard therapy.
   The common adverse effects associated with tirofiban are bleeding,
thrombocytopenia, musea, fever and headache.
   The usual dose of tirofiban is an IV infusion of 0.4 mcg/kg/min for 30
minutes followed by a maintenance infusion of 0.1 mcg/kg/min. The infusion is
usually continued for 48-72 hours (up to 108) or 12-24 hours after an
intervention.
   An alternative dosing scheme (not included in the package
insert) used in the RESTORE trial has been used by some clinicians for
patients undergoing PTCA or atherectomy. This regimen consists of 10 mcg/kg as
a bolus over 3 minutes followed by an infusion of 0.15 mcg/kg/min for 36 hours.
[NOTE that this had erroneously been recommended at 0.5 mcg/kg/min in a
previous version of this document, taken from the June 1998 Mercy Hospital
Pharmacy and Therapeutics Update.]