Home Drug Guide Argatroban

Drug Guide

Generic Name

Argatroban

Brand Names Argatroban In Sodium Chloride, Argatroban In Dextrose, Argatroban In 0.9% Sodium Chloride

Classification

Therapeutic: Anticoagulant

Pharmacological: Direct Thrombin Inhibitor

FDA Approved Indications

  • Prophylaxis or treatment of thrombosis in patients with heparin-induced thrombocytopenia (HIT)

Mechanism of Action

Argatroban reversibly binds to the active site of thrombin, directly inhibiting its activity and thereby preventing fibrin formation, activation of coagulation factors V and XIII, and platelet aggregation.

Dosage and Administration

Adult: Initial infusion rate of 2 mcg/kg/min, titrated to achieve target activated partial thromboplastin time (aPTT) 1.5 to 3 times baseline; usual max dose 10 mcg/kg/min.

Pediatric: Not FDA approved, limited data; use with caution and under specialist guidance.

Geriatric: Lower initial doses may be considered due to increased bleeding risk; close monitoring recommended.

Renal Impairment: Adjust dosing based on renal function; no specific dose adjustment, but caution advised.

Hepatic Impairment: No specific dose adjustment; monitor bleeding closely.

Pharmacokinetics

Absorption: Not applicable (administered IV).

Distribution: Moderate volume of distribution (~174 mL/kg).

Metabolism: Hepatic metabolism via CYP3A4/5 enzymes.

Excretion: Primarily hepatic; minimal renal elimination.

Half Life: Approximately 40 minutes in healthy subjects; may be prolonged in hepatic impairment.

Contraindications

  • Active major bleeding
  • Known hypersensitivity to Argatroban

Precautions

  • Hepatic impairment (dose adjustment may be necessary)
  • Use with caution in patients at high bleeding risk
  • Monitor hepatic function regularly

Adverse Reactions - Common

  • Bleeding (Very common)
  • Back pain (Common)
  • Elevated liver enzymes (Common)

Adverse Reactions - Serious

  • Major bleeding (e.g., intracranial, GI hemorrhage) (Serious/rare)
  • Hypersensitivity reactions (Rare)

Drug-Drug Interactions

  • Other anticoagulants (increased bleeding risk)
  • Antiplatelet agents

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor aPTT levels regularly, signs of bleeding, hepatic function.

Diagnoses:

  • Risk for bleeding
  • Impaired tissue perfusion

Implementation: Administer via IV infusion; adjust dose based on aPTT; monitor for bleeding and hepatic function.

Evaluation: Achievement of therapeutic aPTT without excessive bleeding.

Patient/Family Teaching

  • Report signs of bleeding immediately
  • Do not discontinue without medical advice
  • Inform healthcare providers of Argatroban use prior to any procedures

Special Considerations

Black Box Warnings:

  • Excessive bleeding risk

Genetic Factors: No specific genetic markers required for dosing.

Lab Test Interference: May affect coagulation tests, including aPTT, INR.

Overdose Management

Signs/Symptoms: Severe bleeding, hypotension, shock.

Treatment: Discontinue Argatroban; provide supportive measures, including blood products; use of idarucizumab is not indicated as it's not a reversal agent for Argatroban.

Storage and Handling

Storage: Store at room temperature 20-25°C (68-77°F); protect from light.

Stability: Stable for the duration of infusion; discard if solution is discolored or contains particulate matter.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.