Interacting drugs-summary

 Aprotinin +

Aprotinin + Captopril

Produces acute hypotensive effect

Aprotinin + Fibrinolitic agents

Inhibit effect of fibronolytics

Aprotinin + Heparin

Prolong activated clotting time

Fibrinolytic agents  is known to have antifibrolytic activity and therefore, may inhibit the effect of fibrinolytic agents.

In the presence of heparin, has been found to prolong the activated clotting time. however, aprotinin should be viewed as a heparin-sparing agent.

Incompatible with most corticosteroids,nutrient solutions containing aminoacids and fat emulsions and tetracyclines.

Avoid mixed infusion particularly with Beta-lactum antibiotics.

Reduction of blood loss in CABG- (coronary artery bypass graft)

Aprotonin adverse reactions

Artrial fibrilation 25%   Myocardial infarction 10%  Heart failure 8%  Artial flutter 7%

 Ventricular tachycardia 5%   Fever 5%   Hypotension 4% 

Pneumonia 4%  Respiratory disorder 4%

 Heart arrest 3 %  Congestive heart failure 3% Supraventricular tachycardia 3% 

Kidney failure 3%  Sepsis 3%   Apnea 3%  Confusion 3%  Heart block 2% 

Shock 2%   Asthma 2%  Dyspnea 2%

Hypersens.

Special precautions: Neonates and children,first trimester of pregnancy.

Test dose- all patients treated with aprotonin shouldfirst receive a test dose to assess the potential for allergic reaction. administer 1 ml test dose of aprotonin IV at least 10 minutes prior to loading dose.

Loading dose- give the loading dose ofaprotonin IV to patients inthe supine position over 20 to 30 minutes periood. Rapid IV administration of aprotonin can cause a transcient fall in blood pressure .

Renal failiure/mortality- an increase in both renal and hepatic failure mortality comparedto age mastched historical controls has been reported in patients receiving aprotonin while undergoing deep hypothermic circulatory arrest in conection with surgery of the aortic arch.

Hepatic failure- . Whole blood clotting time- aprotonin prolongs whole blood clotting time of heparinized blood as determined by the Hemochron method or similar surface activation methods.

Warnings-

Hypersentivity- patients who experience allergic reactions to the test dose of aprotonin should not receive further administration of the drug.

Pregnancy- use during pregnancy only if clearly needed.

Safety - safety and efficacy have not been established

Reduction of blood loss in CABG- (coronary artery bypass graft)

Dosage- Regimen A 2 million KIU IV loading dose , 2 milion KIU into the pump prime volume 500, 000 KIU/hr of operation as continous  IV infusion

Regimen B- 1 million KIU IV loading dose , 1 milion KIU into the pump prime volume 250, 000 KIU/hr of operation as continous IVinfusion.

Overdosage- The maximum amount of aprotonin that can be safely administred in a single or multiple doses has not been determined Doses upto 17.5 million KIU have been administered within 24 hour period without any apparent toxicity.

Pharmacology:

Aprotinin is a natural protease inhibitor obtained from bovine lung with a variety of effects on the coagulation system. It inhibits plasminin and kallikrein , thus directlty affecting fibronolysis

Pharmakokinetics:

Rapid distribution of aprotinin occurs into the total extracellular space, leading to a rapid initial decrease in plasma concentrationA plasma half-life of 150 minutes is observed.

Not known.

Pregnancy

Use during pregnancy only if clearly needed.

 Safety and efficacy have not been established