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GPIIb/IIIa Receptor Antagonist (Cyclic Peptide) Pregnancy: Contraindicated — insufficient data; use only for life-threatening ACS.

Eptifibatide (GPIIb/IIIa Inhibitor — ACS/PCI)

Brand names: Integrilin

Adult dose

Dose: ACS (medical management): 180 mcg/kg IV bolus then 2 mcg/kg/min infusion for 72–96 hours. PCI: 180 mcg/kg IV bolus before PCI then second bolus 10 min later; infusion 2 mcg/kg/min for 18–24 hours post-PCI
Route: IV bolus then infusion
Frequency: Continuous infusion after loading bolus(es)
Max: Infusion: 2 mcg/kg/min; max bolus 22.6 mg; max infusion rate 15 mg/hour
Reversible GPIIb/IIIa antagonist — platelet function recovers within 4 hours of stopping (unlike abciximab — 12–24h). Used in high-risk NSTEMI/UA and as procedural antiplatelet during PCI. Largely superseded by potent oral P2Y12 inhibitors (ticagrelor, prasugrel) in contemporary practice but still used in planned bailout PCI.

Paediatric dose

Route:
Not licensed in paediatrics.

Dose adjustments

Renal

eGFR <50 mL/min: reduce infusion to 1 mcg/kg/min. eGFR <10: avoid.

Hepatic

No dose adjustment required.

Clinical pearls

  • PURSUIT trial (NEJM 1998): eptifibatide in ACS — 15% relative risk reduction in death/MI at 30 days vs placebo. ESPRIT trial (NEJM 2001): eptifibatide in elective PCI — 37% relative RR reduction in 48h death/MI/urgent revascularisation vs placebo. Both established GPIIb/IIIa inhibitors as adjunctive therapy in ACS/PCI
  • Contemporary role: with potent P2Y12 inhibitors (ticagrelor, prasugrel) now standard, GPIIb/IIIa inhibitors are used selectively — bailout for no-reflow during PCI, high-thrombus burden STEMI, or when oral loading is not possible. ESC 2023 PCI guidelines: upstream routine use not recommended; selective use in specific high-risk situations
  • Eptifibatide vs abciximab: eptifibatide (cyclic peptide) has shorter duration of action (~4h after stopping) vs abciximab (antibody — 12–24h); eptifibatide preferred when surgical intervention may be needed urgently after PCI; abciximab not available in UK since 2015

Contraindications

  • Active major bleeding or recent stroke (<30 days)
  • Severe uncontrolled hypertension
  • Major surgery within 6 weeks
  • Platelet count <100 × 10⁹/L
  • Dialysis-dependent renal failure

Side effects

  • Bleeding (major: 1.3% vs 0.5% placebo in ESPRIT — especially access site and GI)
  • Thrombocytopenia (1–2% — check platelet count 4–6 hours after starting)
  • Hypotension during bolus

Interactions

  • Other antiplatelets and anticoagulants (triple/quadruple antithrombotic therapy — markedly increased bleeding; careful risk-benefit required)
  • Thrombolytics (avoid concurrent systemic use)

Monitoring

  • Platelet count at baseline, 4–6 hours, and 24 hours after starting (thrombocytopenia surveillance)
  • Access site (femoral or radial — haemostasis)
  • aPTT (co-administered heparin monitoring)
  • Haematocrit (bleeding detection)
  • Renal function (dose adjustment)

Reference: BNFc; BNF 90; PURSUIT Trial (NEJM 1998); ESPRIT Trial (NEJM 2001); ESC PCI Guidelines 2023; MHRA SPC Integrilin. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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