Percutaneous Transluminal Coronary Angioplasty (PTCA)

Angiomax® (bivalirudin) is indicated for use as an anticoagulant in patients with unstable angina undergoing percutaneous transluminal coronary angioplasty (PTCA).

Percutaneous Coronary Intervention (PCI)

Angiomax (bivalirudin) with provisional use of glycoprotein IIb/IIIa inhibitor (GPI) as listed in the REPLACE-2 trial [see Clinical Studies] is indicated for use as an anticoagulant in patients undergoing percutaneous coronary intervention (PCI).

Angiomax (bivalirudin) is indicated for patients with, or at risk of, heparin induced thrombocytopenia (HIT) or heparin induced thrombocytopenia and thrombosis syndrome (HITTS) undergoing PCI.

Use with Aspirin

Angiomax (bivalirudin) in these indications is intended for use with aspirin and has been studied only in patients receiving concomitant aspirin [see DOSAGE AND ADMINISTRATION and Clinical Studies].

Limitation of Use

The safety and effectiveness of Angiomax (bivalirudin) have not been established in patients with acute coronary syndromes who are not undergoing PTCA or PCI.

Recommended Dose

Angiomax (bivalirudin) is for intravenous administration only.

Angiomax (bivalirudin) is intended for use with aspirin (300-325 mg daily) and has been studied only in patients receiving concomitant aspirin.

For patients who do not have HIT/HITTS

The recommended dose of Angiomax (bivalirudin) is an intravenous (IV) bolus dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for the duration of the PCI/PTCA procedure. Five min after the bolus dose has been administered, an activated clotting time (ACT) should be performed and an additional bolus of 0.3 mg/kg should be given if needed.

GPI administration should be considered in the event that any of the conditions listed in the REPLACE-2 clinical trial description [see Clinical Studies] is present.

For patients who have HIT/HITTS

The recommended dose of Angiomax (bivalirudin) in patients with HIT/HITTS undergoing PCI is an IV bolus of 0.75 mg/kg. This should be followed by a continuous infusion at a rate of 1.75 mg/kg/h for the duration of the procedure.

For ongoing treatment post procedure

Continuation of the Angiomax (bivalirudin) infusion following PCI/PTCA for up to 4 hours post-procedure is optional, at the discretion of the treating physician. After four hours, an additional IV infusion of Angiomax (bivalirudin) may be initiated at a rate of 0.2 mg/kg/h (low-rate infusion), for up to 20 hours, if needed.

Dosing in Renal Impairment

No reduction in the bolus dose is needed for any degree of renal impairment. The infusion dose of Angiomax (bivalirudin) may need to be reduced, and anticoagulant status monitored in patients with renal impairment. Patients with moderate renal impairment (30-59 mL/min) should receive an infusion of 1.75 mg/kg/h. If the creatinine clearance is less than 30 mL/min, reduction of the infusion rate to 1 mg/kg/h should be considered. If a patient is on hemodialysis, the infusion rate should be reduced to 0.25 mg/kg/h [see Use In Specific Population].

Instructions for Administration

Angiomax (bivalirudin) is intended for intravenous bolus injection and continuous infusion after reconstitution and dilution. To each 250 mg vial, add 5 mL of Sterile Water for Injection, USP. Gently swirl until all material is dissolved. Each reconstituted vial should be further diluted in 50 mL of 5% Dextrose in Water or 0.9% Sodium Chloride for Injection to yield a final concentration of 5 mg/mL (e.g., 1 vial in 50 mL; 2 vials in 100 mL; 5 vials in 250 mL). The dose to be administered is adjusted according to the patient's weight (See Table 1).

If the low-rate infusion is used after the initial infusion, a lower concentration bag should be prepared. In order to prepare this bag, reconstitute the 250 mg vial with 5 mL of Sterile Water for Injection, USP. Gently swirl until all material is dissolved. Each reconstituted vial should be further diluted in 500 mL of 5% Dextrose in Water or 0.9% Sodium Chloride for Injection to yield a final concentration of 0.5 mg/mL. The infusion rate to be administered should be selected from the right-hand column in Table 1.

Table 1 : Dosing Table

Angiomax (bivalirudin) should be administered via an intravenous line. No incompatibilities have been observed with glass bottles or polyvinyl chloride bags and administration sets. The following drugs should not be administered in the same intravenous line with Angiomax (bivalirudin) , since they resulted in haze formation, microparticulate formation, or gross precipitation when mixed with Angiomax (bivalirudin) : alteplase, amiodarone HCl, amphotericin B, chlorpromazine HCl, diazepam, prochlorperazine edisylate, reteplase, streptokinase, and vancomycin HCl. Dobutamine was compatible at concentrations up to 4 mg/mL but incompatible at a concentration of 12.5 mg/mL.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Preparations of Angiomax (bivalirudin) containing particulate matter should not be used. Reconstituted material will be a clear to slightly opalescent, colorless to slightly yellow solution.

Storage after Reconstitution

Do not freeze reconstituted or diluted Angiomax (bivalirudin) . Reconstituted material may be stored at 2-8°C for up to 24 hours. Diluted Angiomax (bivalirudin) with a concentration of between 0.5 mg/mL and 5 mg/mL is stable at room temperature for up to 24 hours. Discard any unused portion of reconstituted solution remaining in the vial.

Dosage Forms And Strengths

Angiomax (bivalirudin) is supplied as a sterile, lyophilized powder in single-use, glass vials. After reconstitution, each vial delivers 250 mg of Angiomax (bivalirudin) .

Storage And Handling

Angiomax (bivalirudin) is supplied as a sterile, lyophilized powder in single-use, glass vials. After reconstitution, each vial delivers 250 mg of Angiomax (bivalirudin) .

NDC 65293-001-01

Store Angiomax (bivalirudin) dosage units at 20-25°C (68-77°F). Excursions to 15-30°C permitted. [See USP Controlled Room Temperature.]

Manufactured by: BenVenue Laboratories Bedford, OH. Distributed by: ICS Louisville, KY. Marketed by: The Medicines Company Parsippany, NJ 07054. For information call: (800) 264-4662. Revised: 06/2010

Last reviewed on RxList: 7/20/2010
This monograph has been modified to include the generic and brand name in many instances.