Eptifibatide

Eptifibatide is a reversible intravenous antagonist of the glycoprotein IIb/IIIa receptor on activated platelets. It is a synthetic cyclic heptapeptide that prevents cross-linking of platelets by fibrinogen and von Willebrand factor, thereby inhibiting platelet aggregation.

Indications include treatment of acute coronary syndromes (non-ST elevation ACS and during percutaneous coronary intervention) as an adjunct to anticoagulant therapy to reduce ischemic events. It is typically used in adults when PCI is planned or ongoing and is not for routine chronic therapy. Dosing is weight-based and given as an IV bolus followed by a continuous infusion; duration is guided by clinical scenario and renal function.

Pharmacokinetics: rapid onset with a short half-life of about 2–3 hours; primarily cleared by the kidneys, requiring dose adjustment in renal impairment. The infusion is often stopped when PCI is completed; continued for up to 24–48 hours in ACS depending on bleeding risk and clinical course.

Safety: the most common adverse effect is bleeding, including access-site bleeding and life-threatening hemorrhage. Thrombocytopenia, hypotension, and rare hypersensitivity reactions can occur. It should not be used in patients with active major bleeding, severe thrombocytopenia, intracranial hemorrhage, or significant risk of bleeding, and dose adjustments are required for renal impairment. Concomitant anticoagulants and antiplatelet agents raise bleeding risk and require careful monitoring.

History: eptifibatide was approved by the U.S. FDA in the late 1990s for use in ACS and PCI; marketed under the brand name Integrilin and used worldwide as a GP IIb/IIIa inhibitor.