Abciximab

Abciximab
Monoclonal antibody
TypeFab fragment
SourceChimeric (mouse/human)
TargetCD41 7E3
Names
Trade namesReopro
Other namesAbcixifiban,[1] c7E3 Fab
Clinical data
Drug classGlycoprotein_IIb/IIIa inhibitor[2]
Main usesPercutaneous coronary angioplasty (PCI)[2]
Side effectsBleeding, low blood pressure, nausea, headache, peripheral swelling[2]
Pregnancy
category
  • US: C (Risk not ruled out)
    Routes of
    use    		Intravenous (IV)
    External links
    AHFS/Drugs.comMonograph
    US NLMAbciximab
    Legal
    License data
    Legal status
    Chemical and physical data
    FormulaC2101H3229N551O673S15
    Molar mass47456.03 g·mol−1

    Abciximab, sold under the trade name Reopro, is a medication used around the time of percutaneous coronary angioplasty (PCI).[2] It is given by injection into a vein.[2] Full onset occurs within 10 minutes and lasts up to 48 hours after it is stopped.[2]

    Common side effects include bleeding, low blood pressure, nausea, headache, and peripheral swelling.[2] Other side effects may include anaphylaxis and low platelets.[2] Safety in pregnancy is unclear.[2] It a glycoprotein_IIb/IIIa inhibitor which works by preventing platelets from sticking together.[2]

    Abciximab was approved for medical use in the United States in 1994.[2] In the United States 10 mg costs about 1,300 USD as of 2022.[4]

    Medical uses

    Abciximab is indicated for use in individuals undergoing percutaneous coronary intervention (angioplasty with or without stent placement). The use of abciximab in this setting is associated with a decreased incidence of ischemic complications due to the procedure[5] and a decreased need for repeated coronary artery revascularization in the first month following the procedure.[6]

    Research also shows that this drug can be of use for patients with diabetes and chronic kidney disease. It is not the appropriate drug of choice if a patient is scheduled for an emergency surgery (i.e., heart surgery) because bleeding time may take about 12 hours to normalize. Pediatric uses include treatment of Kawasaki disease.

    Side effects

    Many of the side effects of abciximab are due to its anti-platelet effects which increase the risk of bleeding. The most common type of bleeding due to abciximab is gastrointestinal hemorrhage.

    Thrombocytopenia is a rare but known serious risk characterized by a severe drop in platelets circulating in the blood. Abciximab induced thrombocytopenia is usually rapid occurring hours after administration but may occur up to 16 days later.[7] Transfusing platelets is the only known treatment for abciximab-induced thrombocytopenia, but this therapy may have limited effectiveness because the drug may bind and inhibit the receptors on the newly transfused platelets.

    Pharmacokinetics

    Abciximab has a plasma half-life of about ten minutes, with a second phase half-life of about 30 minutes. However, its effects on platelet function can be seen for up to 48 hours after the infusion has been terminated, and low levels of glycoprotein IIb/IIIa receptor blockade are present for up to 15 days after the infusion is terminated. Abciximab does not require dose adjustments for patients with kidney failure.[8]

    While abciximab has a short plasma half-life, due to its strong affinity for its receptor on the platelets, it may occupy some receptors for weeks. In practice, platelet aggregation gradually returns to normal about 96 to 120 hours after discontinuation of the drug. Abciximab is made from the Fab fragments of an immunoglobulin that targets the glycoprotein IIb/IIIa receptor on the platelet membrane.[9]

    References

    1. ↑ Tabbaa, Rahaf. "Comprehensive Medical Reference & Review for Mccqe and Usmle Ii". Archived from the original on 2022-02-18. Retrieved 2021-07-11. {{cite journal}}: Cite journal requires |journal= (help)
    2. 1 2 3 4 5 6 7 8 9 10 11 "Abciximab Monograph for Professionals". Drugs.com. Archived from the original on 4 January 2021. Retrieved 13 January 2022.
    3. ↑ "Archive copy" (PDF). Archived (PDF) from the original on 2021-03-30. Retrieved 2021-07-11.{{cite web}}: CS1 maint: archived copy as title (link)
    4. ↑ "ReoPro Prices, Coupons & Patient Assistance Programs". Drugs.com. Archived from the original on 10 February 2018. Retrieved 13 January 2022.
    5. ↑ EPIC Investigators (April 1994). "Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty". The New England Journal of Medicine. 330 (14): 956–61. doi:10.1056/NEJM199404073301402. PMID 8121459.
    6. ↑ Tcheng JE, Kandzari DE, Grines CL, Cox DA, Effron MB, Garcia E, et al. (September 2003). "Benefits and risks of abciximab use in primary angioplasty for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial". Circulation. 108 (11): 1316–23. doi:10.1161/01.CIR.0000087601.45803.86. PMID 12939213.
    7. ↑ Webb GJ, Swinburn JM, Grech H (2011). "Profound delayed thrombocytopenia presenting 16 days after Abciximab (Reopro) administration". Platelets. 22 (4): 302–4. doi:10.3109/09537104.2010.518324. PMID 21526887. S2CID 40372407.
    8. ↑ Usta C, Turgut NT, Bedel A (November 2016). "How abciximab might be clinically useful". International Journal of Cardiology. 222: 1074–1078. doi:10.1016/j.ijcard.2016.07.213. PMID 27519521.
    9. ↑ "International Nonproprietary Names for Pharmaceutical Substances" (PDF). WHO Drug Information. 7 (4). 1993. Archived (PDF) from the original on 2015-04-05. Retrieved 2021-07-11.
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