UNIGRILIN (EPTIFIBATIDE) 75MG/100ML INJ VIAL

Eptifibatide is a cyclic heptapeptide that reversibly inhibits the platelet glycoprotein IIb/IIIa receptor — the final common pathway for platelet aggregation. By blocking fibrinogen and von Willebrand factor from binding to this receptor, eptifibatide prevents platelets from clumping together to form dangerous clots in coronary arteries.

It is used in hospital settings for:

•       Non-ST-elevation acute coronary syndrome (NSTE-ACS) — unstable angina or NSTEMI — in patients scheduled for early percutaneous coronary intervention (PCI), in combination with unfractionated heparin and aspirin.

•       Prevention of early thrombotic complications during and after elective or urgent PCI, including patients undergoing intracoronary stent placement.

Eptifibatide is administered exclusively by trained medical staff in a hospital or cardiac catheterisation suite. It is given intravenously as:

•       A bolus injection (180 mcg/kg IV bolus from the 2 mg/mL vial — not this 0.75 mg/mL infusion vial), followed immediately by:

•       A continuous IV infusion at 2 mcg/kg/min (from this 0.75 mg/mL vial) for up to 72 hours (NSTE-ACS) or up to 18–24 hours post-PCI.

The 75 mg/100 mL (0.75 mg/mL) concentration is specifically designed for the maintenance infusion. Dosing is weight-based — the clinical pharmacist or cardiologist calculates the infusion rate based on patient weight.

•       Other antiplatelet agents (aspirin, clopidogrel, ticagrelor, prasugrel): additive bleeding risk — routinely co-administered per ACS protocol under specialist supervision.

•       Thrombolytics (alteplase, streptokinase): significantly increased bleeding risk — generally contraindicated with GP IIb/IIIa inhibitors.

•       Anticoagulants (UFH, LMWH, warfarin, NOACs): co-administration increases bleeding risk — monitor closely; UFH co-administration is standard per protocol.

•       NSAIDs: additive platelet inhibition — avoid.

Store at 2–8°C (refrigerate). Protect from light. Do not freeze. The infusion solution is for single use only. Once opened/connected, use within 24 hours. Inspect visually — discard if discoloured or particulate matter visible. Dispose of unused solution per hospital hazardous waste protocol.

Eptifibatide is given to you in hospital to prevent further clot formation in the arteries supplying your heart during or after a heart attack or coronary procedure. The most important risk is bleeding — you will be closely monitored throughout the infusion. Let your nurse know immediately if you notice unusual bruising, bleeding gums, blood in your urine, black stools, or any sudden headache or vision change.

After the infusion is stopped, its platelet-inhibiting effect wears off within 4 hours because eptifibatide reversibly binds to its receptor, unlike some other antiplatelet agents.

The 75 mg/100 mL (0.75 mg/mL) vial is the maintenance infusion concentration. The separate 2 mg/mL vial is used to prepare the initial 180 mcg/kg IV bolus.

Do not confuse concentrations. Infusion rate: 2 mcg/kg/min for standard renal function; 1 mcg/kg/min if CrCl 10–50 mL/min.

Maximum duration: 72 hours (NSTE-ACS) or 18–24 hours post-PCI. Platelet count must be checked at baseline; if thrombocytopenia develops (< 100,000/mcL), immediately discontinue.

Post-procedure: leave arterial sheath in place and do not remove until aPTT < 45 seconds or ACT < 150 seconds to minimise access-site bleeding.

Can eptifibatide be reversed if there is serious bleeding?

There is no specific antidote. Management involves stopping the infusion, applying compression, and — in extreme cases — platelet transfusion (though eptifibatide rapidly dissociates from transfused platelets given its reversible binding).

Can eptifibatide be used with low molecular weight heparin?

Yes — enoxaparin is an acceptable alternative to UFH with eptifibatide in NSTE-ACS, with last dose > 8 hours before PCI requiring a UFH supplement per protocol. Consult current ACS guidelines for specific co-administration recommendations.

Why is eptifibatide contraindicated in renal failure?

Eptifibatide and its metabolite are primarily renally excreted. In severe renal failure (creatinine > 4 mg/dL or dialysis), drug accumulation leads to markedly prolonged platelet inhibition and prohibitive bleeding risk.

Does eptifibatide work better than newer antiplatelet agents?

Eptifibatide is most valuable in the PCI setting where rapid, reversible, potent platelet inhibition is needed during the procedure. For long-term secondary prevention, oral P2Y12 inhibitors (ticagrelor, clopidogrel) are used.

What are the signs of thrombocytopenia to watch for?

Unusual bruising (petechiae, purpura), unexplained bleeding from skin or mucous membranes, blood in urine or stools. A blood test confirms the diagnosis — your team will check platelet counts regularly during the infusion.