Assessment of eptifibatide clearance by hemodialysis using an in vitro system.
OBJECTIVE
Eptifibatide is a parenteral glycoprotein IIb-IIIa inhibitor that prevents platelet aggregation. Although contraindicated in dialysis patients due to limited safety and dialysis data, eptifibatide is prescribed in this population and is associated with bleeding complications. This study was done to determine dialysis clearance (CL(D)) of eptifibatide using an in vitro system.


METHODS
Three common dialyzers were tested. In vitro dialysis was performed at a dialysate flow rate of 500 ml/min, 'blood' flow rate (Q(B)) of 200 and 400 ml/min, and the minimal ultrafiltration rate. Eptifibatide CL(D) and fraction removed were calculated for each condition.


RESULTS
CL(D) ranged from 122 to 225 ml/min and was not significantly different among the dialyzers tested. CL(D) was flow dependent with higher clearances observed at higher Q(B). The estimated fraction of eptifibatide removed was 73-83%.


CONCLUSIONS
These data suggest that hemodialysis is an effective method to decrease the effects of eptifibatide in patients with impaired kidney function.
Department of Clinical Pharmacy, The University of Tennessee Health Science Center, 910 Madison, Memphis, TN 38163-0001, USA. jhudson@uthsc.edu
Joanna Q
JQ
Hudson
Elizabeth B
EB
McNeely
Christie A
CA
Green
Lisa K
LK
Jennings
D000075202:Contraindications; D003404:Creatinine / Q000032:analysis*; D000077542:Eptifibatide; D004864:Equipment and Supplies / Q000592:standards*; D017583:Hemodiafiltration / Q000592:standards; D015312:Hemodialysis Solutions / Q000737:chemistry; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D066298:In Vitro Techniques; D007263:Infusions, Parenteral; D010455:Peptides / Q000009:adverse effects / Q000493:pharmacokinetics*; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D014508:Urea / Q000032:analysis*
D015312:Hemodialysis Solutions; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014508:Urea; D003404:Creatinine; D000077542:Eptifibatide