Aprotinin

Indications
Intravenous
Haemorrhage
Adult: Admin a test dose of 10,000 KIU at least 10 minutes before starting treatment. Loading dose: 500,000-1,000,000 KIU, given by slow inj or infusion (max rate: 100,000 KIU/minute) with the patient in supine position, may continue with 200,000 KIU/hr until the haemorrhage is controlled. Doses to be given via central venous line.
Child: 1 mth-18 yr: Test dose of 200 KIU/kg, followed after 10 minutes by a dose of 10,000 KIU/kg given over 20 minutes, then continuous infusion of 3,000 KIU/kg/hr until bleeding is controlled.
Intravenous
Open heart surgery
Adult: Admin a test dose of 10,000 KIU at least 10 minutes before starting treatment. Loading dose: 2,000,000 KIU over 20-30 minutes after induction of anaesthesia but before incision or reopening of wound, followed by continuous infusion of 500,000 KIU/hr until the end of the surgery. Add an additional dose of 2,000,000 KIU into the prime volume of the extracorporeal circuit. Doses to be given via central venous line. For patients with septic endocarditis, add a dose of 3 000 000 KIU into the prime volume of the circuit; may continue infusion into the early postoperative period. Usual total amount ≤7 000 000 KIU.

Incompatibility: Incompatible with corticosteroids, heparin, tetracyclines, and nutrient solutions containing amino acids or fat emulsions.
Contraindications
Hypersensitivity.
Warnings / Precautions
Test dose should be administered to all patients at least 10 minutes before loading dose to assess for risk of hypersensitvity. Neonates and children. Greater risk of anaphylactic reactions upon re-exposure within 12 mth of previous use. Renal impairment. Pregnancy, lactation. Activated clotting time may not be a reliable method to monitor heparin therapy when on aprotinin treatment.
Adverse Reactions
Fever and nausea. GI disturbances. Hypersensitivity or pseudo-allergic reactions may occur after 1st dose or thereafter e.g. skin rashes and eruptions, tachycardia, pallor or cyanosis, dyspnoea and anaphylactic shock.
Potentially Fatal: Fatal anaphylactic reactions.
Drug Interactions
May reduce hypotensive action of captopril and enalapril. Risk of apnoea when used with neuromuscular blockers. Risk of fatal thrombotic complications when used with tretinoin.
See Below for More aprotinin Drug Interactions
Lab Interactions
Prolongs clotting time of heparinised blood.
Mechanism of Actions
Aprotinin is a polypeptide and inhibits proteolytic enzymes including trypsin, chymotrypsin, kallikrein and plasmin. Inhibition of plasmin inhibits fibrinolysis and reduces operative blood loss.
Metabolism: Inactivated in the GI tract.
Excretion: Via urine as inactive degradation products; 5-10 hr (elimination half-life).
Storage Conditions
Intravenous: Store at 2-25°C.
ATC Classification
B02AB01 - aprotinin ; Belongs to the class of proteinase inhibitor antifibrinolytics. Used in the treatment of hemorrhage.
Storage
Intravenous: Store at 2-25°C.
Available As
  • Aprotinin 1.4 mg
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