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Identification
NameBivalirudin
Accession NumberDB00006  (BTD00076, BIOD00076)
TypeSmall Molecule
GroupsApproved, Investigational
DescriptionBivalirudin is a synthetic 20 residue peptide (thrombin inhibitor) which reversibly inhibits thrombin. Once bound to the active site, thrombin cannot activate fibrinogen into fibrin, the crucial step in the formation of thrombus. It is administered intravenously. Because it can cause blood stagnation, it is important to monitor changes in hematocrit, activated partial thromboplastin time, international normalized ratio and blood pressure.
Structure
Thumb
SynonymsNot Available
External Identifiers Not Available
Approved Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Angiomaxinjection, powder, lyophilized, for solution250 mg/1intravenousThe Medicines Company2000-12-15Not applicableUs
Angiomaxinjection, powder, lyophilized, for solution250 mg/1intravenousCardinal Health2000-12-15Not applicableUs
Angiomaxpowder for solution250 mgintravenousSunovion Pharmaceuticals Canada Inc2003-05-08Not applicableCanada
Bivalirudininjection, powder, lyophilized, for solution250 mg/1intravenousSandoz2015-06-15Not applicableUs
Bivalirudininjection, powder, lyophilized, for solution250 mg/1intravenousSandoz2015-10-23Not applicableUs
Bivalirudinpowder for solution250 mgintravenousSandoz Canada IncorporatedNot applicableNot applicableCanada
Bivalirudin for Injectionpowder for solution250 mgintravenousFresenius Kabi Canada LtdNot applicableNot applicableCanada
Approved Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Bivalirudininjection, powder, lyophilized, for solution250 mg/1intravenousHospira, Inc.2015-07-14Not applicableUs
Approved Over the Counter ProductsNot Available
Unapproved/Other Products Not Available
International Brands
NameCompany
AngioxNot Available
Brand mixturesNot Available
SaltsNot Available
Categories
UNIITN9BEX005G
CAS number128270-60-0
WeightAverage: 2180.2853
Monoisotopic: 2178.985813062
Chemical FormulaC98H138N24O33
InChI KeyOIRCOABEOLEUMC-GEJPAHFPSA-N
InChI
InChI=1S/C98H138N24O33/c1-5-52(4)82(96(153)122-39-15-23-70(122)92(149)114-60(30-34-79(134)135)85(142)111-59(29-33-78(132)133)86(143)116-64(43-55-24-26-56(123)27-25-55)89(146)118-67(97(154)155)40-51(2)3)119-87(144)61(31-35-80(136)137)112-84(141)58(28-32-77(130)131)113-88(145)63(42-54-18-10-7-11-19-54)117-90(147)66(45-81(138)139)110-76(129)50-107-83(140)65(44-71(100)124)109-75(128)49-106-73(126)47-104-72(125)46-105-74(127)48-108-91(148)68-21-13-38-121(68)95(152)62(20-12-36-103-98(101)102)115-93(150)69-22-14-37-120(69)94(151)57(99)41-53-16-8-6-9-17-53/h6-11,16-19,24-27,51-52,57-70,82,123H,5,12-15,20-23,28-50,99H2,1-4H3,(H2,100,124)(H,104,125)(H,105,127)(H,106,126)(H,107,140)(H,108,148)(H,109,128)(H,110,129)(H,111,142)(H,112,141)(H,113,145)(H,114,149)(H,115,150)(H,116,143)(H,117,147)(H,118,146)(H,119,144)(H,130,131)(H,132,133)(H,134,135)(H,136,137)(H,138,139)(H,154,155)(H4,101,102,103)/t52-,57+,58-,59-,60-,61-,62-,63-,64-,65-,66-,67-,68-,69-,70-,82-/m0/s1
IUPAC Name
(4S)-4-[(2S)-2-[(2S)-2-[(2S)-2-{2-[(2S)-2-(2-{2-[2-(2-{[(2S)-1-[(2S)-2-{[(2S)-1-[(2R)-2-amino-3-phenylpropanoyl]pyrrolidin-2-yl]formamido}-5-carbamimidamidopentanoyl]pyrrolidin-2-yl]formamido}acetamido)acetamido]acetamido}acetamido)-3-carbamoylpropanamido]acetamido}-3-carboxypropanamido]-3-phenylpropanamido]-4-carboxybutanamido]-4-{[(2S,3S)-1-[(2S)-2-{[(1S)-3-carboxy-1-{[(1S)-3-carboxy-1-{[(1S)-1-{[(1S)-1-carboxy-3-methylbutyl]carbamoyl}-2-(4-hydroxyphenyl)ethyl]carbamoyl}propyl]carbamoyl}propyl]carbamoyl}pyrrolidin-1-yl]-3-methyl-1-oxopentan-2-yl]carbamoyl}butanoic acid
SMILES
CC[[email protected]](C)[[email protected]](NC(=O)[[email protected]](CCC(O)=O)NC(=O)[[email protected]](CCC(O)=O)NC(=O)[[email protected]](CC1=CC=CC=C1)NC(=O)[[email protected]](CC(O)=O)NC(=O)CNC(=O)[[email protected]](CC(N)=O)NC(=O)CNC(=O)CNC(=O)CNC(=O)CNC(=O)[C@@H]1CCCN1C(=O)[[email protected]](CCCNC(N)=N)NC(=O)[C@@H]1CCCN1C(=O)[[email protected]](N)CC1=CC=CC=C1)C(=O)N1CCC[[email protected]]1C(=O)N[C@@H](CCC(O)=O)C(=O)N[C@@H](CCC(O)=O)C(=O)N[C@@H](CC1=CC=C(O)C=C1)C(=O)N[C@@H](CC(C)C)C(O)=O
Taxonomy
DescriptionThis compound belongs to the class of organic compounds known as polypeptides. These are peptides containing ten or more amino acid residues.
KingdomOrganic compounds
Super ClassOrganic Polymers
ClassPolypeptides
Sub ClassNot Available
Direct ParentPolypeptides
Alternative Parents
Substituents
  • Polypeptide
  • Alpha peptide
  • Hexacarboxylic acid or derivatives
  • N-acyl-aliphatic-alpha amino acid
  • N-acyl-alpha amino acid or derivatives
  • N-acyl-alpha-amino acid
  • Alpha-amino acid amide
  • N-acyl-l-alpha-amino acid
  • Phenylpropylamine
  • Amphetamine or derivatives
  • Alpha-amino acid or derivatives
  • N-substituted-alpha-amino acid
  • Pyrrolidine-2-carboxamide
  • Pyrrolidine carboxylic acid or derivatives
  • N-acylpyrrolidine
  • Aralkylamine
  • Phenol
  • Amino fatty acid
  • Fatty acyl
  • Benzenoid
  • N-acyl-amine
  • Fatty amide
  • Monocyclic benzene moiety
  • Tertiary carboxylic acid amide
  • Pyrrolidine
  • Tertiary amine
  • Secondary carboxylic acid amide
  • Primary carboxylic acid amide
  • Guanidine
  • Carboxamide group
  • Azacycle
  • Organoheterocyclic compound
  • Carboximidamide
  • Carboxylic acid
  • Carboxylic acid derivative
  • Carboxylic acid amide
  • Hydrocarbon derivative
  • Primary amine
  • Organooxygen compound
  • Organonitrogen compound
  • Primary aliphatic amine
  • Imine
  • Carbonyl group
  • Amine
  • Aromatic heteromonocyclic compound
Molecular FrameworkAromatic heteromonocyclic compounds
External Descriptors
Pharmacology
IndicationFor treatment of heparin-induced thrombocytopenia and for the prevention of thrombosis. Bivalirudin is indicated for use in patients undergoing percutaneous coronary intervention (PCI), in patients at moderate to high risk acute coronary syndromes due to unstable angina or non-ST segment elevation in whom a PCI is planned.
PharmacodynamicsBivalirudin directly and reversibly inhibits thrombin by specifically binding both to the catalytic site and to the anion-binding exosite of circulating and clot-bound thrombin. The action of bivalirudin is reversible because thrombin will slowly cleave the thrombin-bivalirudin bond which recovers the active site of thrombin.
Mechanism of actionInhibits the action of thrombin by binding both to its catalytic site and to its anion-binding exosite. Thrombin is a serine proteinase that plays a central role in the thrombotic process, acting to cleave fibrinogen into fibrin monomers and to activate Factor XIII to Factor XIIIa, allowing fibrin to develop a covalently cross-linked framework which stabilizes the thrombus; thrombin also activates Factors V and VIII, promoting further thrombin generation, and activates platelets, stimulating aggregation and granule release.
Related Articles
AbsorptionFollowing intravenous administration, bivalirudin exhibits linear pharmacokinetics . The mean steady state concentration is 12.3 +/- 1.7mcg/mL after administration of an intravenous bolus of 1mg/kg followd by a 2.5mg/kg/hr intravenous infusion given over 4 hours.
Volume of distribution

0.2L/kg

Protein bindingOther than thrombin and red blood cells, bivalirudin does not bind to plasma proteins.
Metabolism

80% proteolytic cleavage

Route of eliminationBivalirudin is cleared from plasma by a combination of renal mechanisms (20%) and proteolytic cleavage.
Half life* Normal renal function: 25 min (in normal conditions) * Creatinine clearance 10-29mL/min: 57min * Dialysis-dependant patients: 3.5h
Clearance
  • 3.4 mL/min/kg [Normal renal function]
  • 3.4 mL/min/kg [mild renal function]
  • 2.7 mL/min/kg [moderate renal function]
  • 2.8 mL/min/kg [severe renal function]
  • 1 mL/min/kg [Dialysis-dependent patients]
ToxicityBased on a study by Gleason et al., the no-observed-adverse-effect level (NOAEL) for bivalirudin, administered to rats via intravenous infusion over a 24-hour period, was 2000 mg/kg/24 h.
Affected organisms
  • Humans and other mammals
Pathways
PathwayCategorySMPDB ID
Bivalirudin Action PathwayDrug actionSMP00277
SNP Mediated EffectsNot Available
SNP Mediated Adverse Drug ReactionsNot Available
ADMET
Predicted ADMET features
PropertyValueProbability
Human Intestinal AbsorptionNot AvailableNot Available
Blood Brain BarrierNot AvailableNot Available
Caco-2 permeableNot AvailableNot Available
P-glycoprotein substrateNot AvailableNot Available
P-glycoprotein inhibitor INot AvailableNot Available
P-glycoprotein inhibitor IINot AvailableNot Available
Renal organic cation transporterNot AvailableNot Available
CYP450 2C9 substrateNot AvailableNot Available
CYP450 2D6 substrateNot AvailableNot Available
CYP450 3A4 substrateNot AvailableNot Available
CYP450 1A2 substrateNot AvailableNot Available
CYP450 2C9 inhibitorNot AvailableNot Available
CYP450 2D6 inhibitorNot AvailableNot Available
CYP450 2C19 inhibitorNot AvailableNot Available
CYP450 3A4 inhibitorNot AvailableNot Available
CYP450 inhibitory promiscuityNot AvailableNot Available
Ames testNot AvailableNot Available
CarcinogenicityNot AvailableNot Available
BiodegradationNot AvailableNot Available
Rat acute toxicityNot AvailableNot applicable
hERG inhibition (predictor I)Not AvailableNot Available
hERG inhibition (predictor II)Not AvailableNot Available
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397 )
Pharmacoeconomics
Manufacturers
  • The medicines co
Packagers
Dosage forms
FormRouteStrength
Powder for solutionintravenous250 mg
Injection, powder, lyophilized, for solutionintravenous250 mg/1
Prices
Unit descriptionCostUnit
Angiomax 250 mg vial780.0USD vial
DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)
CA2065150 No1999-12-142010-08-17Canada
US5196404 No1993-05-232010-05-23Us
US7582727 Yes2009-01-272029-01-27Us
US7598343 Yes2009-01-272029-01-27Us
Properties
StateLiquid
Experimental Properties
PropertyValueSource
Predicted Properties
PropertyValueSource
Water Solubility0.0464 mg/mLALOGPS
logP-0.76ALOGPS
logP-14ChemAxon
logS-4.7ALOGPS
pKa (Strongest Acidic)2.79ChemAxon
pKa (Strongest Basic)11.88ChemAxon
Physiological Charge-4ChemAxon
Hydrogen Acceptor Count37ChemAxon
Hydrogen Donor Count28ChemAxon
Polar Surface Area901.57 Å2ChemAxon
Rotatable Bond Count66ChemAxon
Refractivity543.33 m3·mol-1ChemAxon
Polarizability215.46 Å3ChemAxon
Number of Rings6ChemAxon
Bioavailability0ChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleYesChemAxon
MDDR-like RuleYesChemAxon
Spectra
Mass Spec (NIST)Not Available
SpectraNot Available
References
Synthesis Reference

Avi Tovi, Chaim Eidelman, Shimon Shushan, Alon Hagi, Alexander Ivchenko, Gabriel-Marcus Butilca, Leah Bar-Oz, Tehila Gadi, Gil Zaovi, “Process for production of Bivalirudin.” U.S. Patent US20070093423, issued April 26, 2007.

US20070093423
General References
  1. Seybert AL, Coons JC, Zerumsky K: Treatment of heparin-induced thrombocytopenia: is there a role for bivalirudin? Pharmacotherapy. 2006 Feb;26(2):229-41. [PubMed:16466327 ]
  2. Dager WE, Dougherty JA, Nguyen PH, Militello MA, Smythe MA: Heparin-induced thrombocytopenia: treatment options and special considerations. Pharmacotherapy. 2007 Apr;27(4):564-87. [PubMed:17381384 ]
  3. Dang CH, Durkalski VL, Nappi JM: Evaluation of treatment with direct thrombin inhibitors in patients with heparin-induced thrombocytopenia. Pharmacotherapy. 2006 Apr;26(4):461-8. [PubMed:16553503 ]
  4. Robson R: The use of bivalirudin in patients with renal impairment. J Invasive Cardiol. 2000 Dec;12 Suppl F:33F-6. [PubMed:11156732 ]
  5. Van De Car DA, Rao SV, Ohman EM: Bivalirudin: a review of the pharmacology and clinical application. Expert Rev Cardiovasc Ther. 2010 Dec;8(12):1673-81. doi: 10.1586/erc.10.158. [PubMed:21108549 ]
  6. Shammas NW: Bivalirudin: pharmacology and clinical applications. Cardiovasc Drug Rev. 2005 Winter;23(4):345-60. [PubMed:16614733 ]
  7. Gleason TG, Chengelis CP, Jackson CB, Lindstrom P: A 24-hour continuous infusion study of bivalirudin in the rat. Int J Toxicol. 2003 May-Jun;22(3):195-206. [PubMed:12851152 ]
External Links
ATC CodesB01AE06
AHFS Codes
  • 20:12.04.12
PDB Entries
FDA labelDownload (60.4 KB)
MSDSNot Available
Interactions
Drug Interactions
Drug
AbacavirThe serum concentration of Abacavir can be decreased when it is combined with Bivalirudin.
AbciximabBivalirudin may increase the anticoagulant activities of Abciximab.
AceclofenacAceclofenac may increase the anticoagulant activities of Bivalirudin.
AcenocoumarolBivalirudin may increase the anticoagulant activities of Acenocoumarol.
Acetylsalicylic acidAcetylsalicylic acid may increase the anticoagulant activities of Bivalirudin.
AdapaleneAdapalene may increase the anticoagulant activities of Bivalirudin.
AlfuzosinThe serum concentration of Alfuzosin can be increased when it is combined with Bivalirudin.
AllylestrenolThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Allylestrenol.
AlprazolamThe serum concentration of Alprazolam can be increased when it is combined with Bivalirudin.
AlprostadilAlprostadil may increase the anticoagulant activities of Bivalirudin.
AlteplaseAlteplase may increase the anticoagulant activities of Bivalirudin.
AltrenogestThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Altrenogest.
ALX-0081ALX-0081 may increase the anticoagulant activities of Bivalirudin.
AmineptineThe serum concentration of Amineptine can be increased when it is combined with Bivalirudin.
AminophyllineThe serum concentration of Aminophylline can be decreased when it is combined with Bivalirudin.
Aminosalicylic AcidAminosalicylic Acid may increase the anticoagulant activities of Bivalirudin.
AmitriptylineThe serum concentration of Amitriptyline can be increased when it is combined with Bivalirudin.
AnagrelideAnagrelide may increase the anticoagulant activities of Bivalirudin.
AncrodBivalirudin may increase the anticoagulant activities of Ancrod.
AnistreplaseAnistreplase may increase the anticoagulant activities of Bivalirudin.
AntipyrineAntipyrine may increase the anticoagulant activities of Bivalirudin.
Antithrombin III humanBivalirudin may increase the anticoagulant activities of Antithrombin III human.
ApixabanApixaban may increase the anticoagulant activities of Bivalirudin.
ApremilastApremilast may increase the anticoagulant activities of Bivalirudin.
AprotininThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Aprotinin.
ArdeparinBivalirudin may increase the anticoagulant activities of Ardeparin.
ArgatrobanBivalirudin may increase the anticoagulant activities of Argatroban.
AstaxanthinAstaxanthin may increase the anticoagulant activities of Bivalirudin.
AtorvastatinThe serum concentration of Atorvastatin can be increased when it is combined with Bivalirudin.
AzapropazoneAzapropazone may increase the anticoagulant activities of Bivalirudin.
AzelastineAzelastine may increase the anticoagulant activities of Bivalirudin.
BalsalazideBalsalazide may increase the anticoagulant activities of Bivalirudin.
BatroxobinBatroxobin may increase the anticoagulant activities of Bivalirudin.
BazedoxifeneBazedoxifene may decrease the anticoagulant activities of Bivalirudin.
BecaplerminBivalirudin may increase the anticoagulant activities of Becaplermin.
BemiparinBemiparin may increase the anticoagulant activities of Bivalirudin.
BenoxaprofenBenoxaprofen may increase the anticoagulant activities of Bivalirudin.
BeraprostBeraprost may increase the anticoagulant activities of Bivalirudin.
BoceprevirThe serum concentration of Bivalirudin can be decreased when it is combined with Boceprevir.
BromfenacBromfenac may increase the anticoagulant activities of Bivalirudin.
BromocriptineThe serum concentration of Bromocriptine can be increased when it is combined with Bivalirudin.
CabergolineThe serum concentration of Cabergoline can be increased when it is combined with Bivalirudin.
CangrelorCangrelor may increase the anticoagulant activities of Bivalirudin.
CarbamazepineThe metabolism of Bivalirudin can be increased when combined with Carbamazepine.
CarprofenCarprofen may increase the anticoagulant activities of Bivalirudin.
CastanospermineCastanospermine may increase the anticoagulant activities of Bivalirudin.
CelecoxibCelecoxib may increase the anticoagulant activities of Bivalirudin.
CertoparinBivalirudin may increase the anticoagulant activities of Certoparin.
ChloroquineChloroquine may increase the anticoagulant activities of Bivalirudin.
ChlorotrianiseneChlorotrianisene may decrease the anticoagulant activities of Bivalirudin.
CilostazolCilostazol may increase the anticoagulant activities of Bivalirudin.
CisaprideThe serum concentration of Cisapride can be increased when it is combined with Bivalirudin.
Citric AcidBivalirudin may increase the anticoagulant activities of Citric Acid.
ClarithromycinThe therapeutic efficacy of Clarithromycin can be decreased when used in combination with Bivalirudin.
ClomipramineThe serum concentration of Clomipramine can be increased when it is combined with Bivalirudin.
ClonixinClonixin may increase the anticoagulant activities of Bivalirudin.
ClopidogrelClopidogrel may increase the anticoagulant activities of Bivalirudin.
CollagenaseThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Collagenase.
Conjugated Equine EstrogensConjugated Equine Estrogens may decrease the anticoagulant activities of Bivalirudin.
CyclobenzaprineThe serum concentration of Cyclobenzaprine can be increased when it is combined with Bivalirudin.
CyclophosphamideThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Cyclophosphamide.
CyclosporineThe serum concentration of Cyclosporine can be increased when it is combined with Bivalirudin.
D-LimoneneD-Limonene may increase the anticoagulant activities of Bivalirudin.
Dabigatran etexilateDabigatran etexilate may increase the anticoagulant activities of Bivalirudin.
DalteparinBivalirudin may increase the anticoagulant activities of Dalteparin.
DanaparoidBivalirudin may increase the anticoagulant activities of Danaparoid.
DasatinibDasatinib may increase the anticoagulant activities of Bivalirudin.
DeferasiroxThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Deferasirox.
DefibrotideDefibrotide may increase the anticoagulant activities of Bivalirudin.
DelavirdineThe serum concentration of Delavirdine can be decreased when it is combined with Bivalirudin.
Deoxycholic AcidThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Deoxycholic Acid.
DesipramineThe serum concentration of Desipramine can be increased when it is combined with Bivalirudin.
DesirudinBivalirudin may increase the anticoagulant activities of Desirudin.
DesmoteplaseDesmoteplase may increase the anticoagulant activities of Bivalirudin.
DesogestrelThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Desogestrel.
DextranBivalirudin may increase the anticoagulant activities of Dextran.
Dextran 40Bivalirudin may increase the anticoagulant activities of Dextran 40.
Dextran 70Bivalirudin may increase the anticoagulant activities of Dextran 70.
Dextran 75Bivalirudin may increase the anticoagulant activities of Dextran 75.
DiclofenacDiclofenac may increase the anticoagulant activities of Bivalirudin.
DicoumarolBivalirudin may increase the anticoagulant activities of Dicoumarol.
DienestrolDienestrol may decrease the anticoagulant activities of Bivalirudin.
DienogestThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Dienogest.
DiethylstilbestrolDiethylstilbestrol may decrease the anticoagulant activities of Bivalirudin.
DiflunisalDiflunisal may increase the anticoagulant activities of Bivalirudin.
DigoxinThe serum concentration of Digoxin can be increased when it is combined with Bivalirudin.
DihydroergotamineThe serum concentration of Dihydroergotamine can be increased when it is combined with Bivalirudin.
DipyridamoleDipyridamole may increase the anticoagulant activities of Bivalirudin.
DitazoleDitazole may increase the anticoagulant activities of Bivalirudin.
DosulepinThe serum concentration of Dosulepin can be increased when it is combined with Bivalirudin.
DoxepinThe serum concentration of Doxepin can be increased when it is combined with Bivalirudin.
DrospirenoneThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Drospirenone.
Drotrecogin alfaDrotrecogin alfa may increase the anticoagulant activities of Bivalirudin.
DroxicamDroxicam may increase the anticoagulant activities of Bivalirudin.
DydrogesteroneThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Dydrogesterone.
DyphyllineThe serum concentration of Dyphylline can be decreased when it is combined with Bivalirudin.
Edetic AcidBivalirudin may increase the anticoagulant activities of Edetic Acid.
EdoxabanEdoxaban may increase the anticoagulant activities of Bivalirudin.
EnfuvirtideThe serum concentration of Enfuvirtide can be increased when it is combined with Bivalirudin.
EnoxaparinBivalirudin may increase the anticoagulant activities of Enoxaparin.
EpinastineEpinastine may increase the anticoagulant activities of Bivalirudin.
EpirizoleEpirizole may increase the anticoagulant activities of Bivalirudin.
EpoprostenolEpoprostenol may increase the anticoagulant activities of Bivalirudin.
EpoprostenolThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Epoprostenol.
EptifibatideEptifibatide may increase the anticoagulant activities of Bivalirudin.
Ergoloid mesylateThe serum concentration of Ergoloid mesylate can be increased when it is combined with Bivalirudin.
ErgonovineThe serum concentration of Ergonovine can be increased when it is combined with Bivalirudin.
ErgotamineThe serum concentration of Ergotamine can be increased when it is combined with Bivalirudin.
EsmirtazapineThe serum concentration of Esmirtazapine can be increased when it is combined with Bivalirudin.
EstradiolEstradiol may decrease the anticoagulant activities of Bivalirudin.
EstriolEstriol may decrease the anticoagulant activities of Bivalirudin.
EstroneEstrone may decrease the anticoagulant activities of Bivalirudin.
EtanerceptEtanercept may increase the anticoagulant activities of Bivalirudin.
Ethinyl EstradiolEthinyl Estradiol may decrease the anticoagulant activities of Bivalirudin.
Ethyl biscoumacetateBivalirudin may increase the anticoagulant activities of Ethyl biscoumacetate.
EtodolacEtodolac may increase the anticoagulant activities of Bivalirudin.
EtofenamateEtofenamate may increase the anticoagulant activities of Bivalirudin.
EtonogestrelThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Etonogestrel.
EtoricoxibEtoricoxib may increase the anticoagulant activities of Bivalirudin.
EtravirineThe serum concentration of Etravirine can be decreased when it is combined with Bivalirudin.
Evening primrose oilEvening primrose oil may increase the anticoagulant activities of Bivalirudin.
exisulindexisulind may increase the anticoagulant activities of Bivalirudin.
FenbufenFenbufen may increase the anticoagulant activities of Bivalirudin.
FenoprofenFenoprofen may increase the anticoagulant activities of Bivalirudin.
FibrinolysinFibrinolysin may increase the anticoagulant activities of Bivalirudin.
FloctafenineFloctafenine may increase the anticoagulant activities of Bivalirudin.
FlunixinFlunixin may increase the anticoagulant activities of Bivalirudin.
FlurbiprofenFlurbiprofen may increase the anticoagulant activities of Bivalirudin.
Fondaparinux sodiumBivalirudin may increase the anticoagulant activities of Fondaparinux sodium.
GarlicThe serum concentration of Bivalirudin can be decreased when it is combined with Garlic.
GenisteinGenistein may decrease the anticoagulant activities of Bivalirudin.
GestodeneThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Gestodene.
HeminHemin may increase the anticoagulant activities of Bivalirudin.
HeparinBivalirudin may increase the anticoagulant activities of Heparin.
HexestrolHexestrol may decrease the anticoagulant activities of Bivalirudin.
HirulogBivalirudin may increase the anticoagulant activities of Hirulog.
HMPL-004HMPL-004 may increase the anticoagulant activities of Bivalirudin.
Hydroxyprogesterone caproateThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Hydroxyprogesterone caproate.
Ibritumomab tiuxetanThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Ibritumomab tiuxetan.
IbrutinibThe risk or severity of adverse effects can be increased when Ibrutinib is combined with Bivalirudin.
IbudilastIbudilast may increase the anticoagulant activities of Bivalirudin.
IbuprofenIbuprofen may increase the anticoagulant activities of Bivalirudin.
IbuproxamIbuproxam may increase the anticoagulant activities of Bivalirudin.
IcatibantIcatibant may increase the anticoagulant activities of Bivalirudin.
Icosapent ethylIcosapent ethyl may increase the anticoagulant activities of Bivalirudin.
IfenprodilIfenprodil may increase the anticoagulant activities of Bivalirudin.
IloprostIloprost may increase the anticoagulant activities of Bivalirudin.
IloprostThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Iloprost.
ImipramineThe serum concentration of Imipramine can be increased when it is combined with Bivalirudin.
IndomethacinIndomethacin may increase the anticoagulant activities of Bivalirudin.
IndoprofenIndoprofen may increase the anticoagulant activities of Bivalirudin.
IsoxicamIsoxicam may increase the anticoagulant activities of Bivalirudin.
KebuzoneKebuzone may increase the anticoagulant activities of Bivalirudin.
KetoprofenKetoprofen may increase the anticoagulant activities of Bivalirudin.
KetorolacKetorolac may increase the anticoagulant activities of Bivalirudin.
LeflunomideLeflunomide may increase the anticoagulant activities of Bivalirudin.
LepirudinLepirudin may increase the anticoagulant activities of Bivalirudin.
LevonorgestrelThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Levonorgestrel.
LimaprostThe risk or severity of adverse effects can be increased when Limaprost is combined with Bivalirudin.
LornoxicamLornoxicam may increase the anticoagulant activities of Bivalirudin.
LovastatinThe serum concentration of Lovastatin can be increased when it is combined with Bivalirudin.
LoxoprofenLoxoprofen may increase the anticoagulant activities of Bivalirudin.
LumiracoxibLumiracoxib may increase the anticoagulant activities of Bivalirudin.
Magnesium salicylateMagnesium salicylate may increase the anticoagulant activities of Bivalirudin.
MasoprocolMasoprocol may increase the anticoagulant activities of Bivalirudin.
Meclofenamic acidMeclofenamic acid may increase the anticoagulant activities of Bivalirudin.
MedrogestoneThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Medrogestone.
Medroxyprogesterone acetateThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Medroxyprogesterone acetate.
Mefenamic acidMefenamic acid may increase the anticoagulant activities of Bivalirudin.
Megestrol acetateThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Megestrol acetate.
MeloxicamMeloxicam may increase the anticoagulant activities of Bivalirudin.
MesalazineMesalazine may increase the anticoagulant activities of Bivalirudin.
MestranolMestranol may decrease the anticoagulant activities of Bivalirudin.
MetamizoleMetamizole may increase the anticoagulant activities of Bivalirudin.
MidazolamThe serum concentration of Midazolam can be increased when it is combined with Bivalirudin.
MilrinoneMilrinone may increase the anticoagulant activities of Bivalirudin.
MirtazapineThe serum concentration of Mirtazapine can be increased when it is combined with Bivalirudin.
Mycophenolate mofetilMycophenolate mofetil may increase the anticoagulant activities of Bivalirudin.
Mycophenolic acidMycophenolic acid may increase the anticoagulant activities of Bivalirudin.
NabumetoneNabumetone may increase the anticoagulant activities of Bivalirudin.
NadroparinBivalirudin may increase the anticoagulant activities of Nadroparin.
NaftifineNaftifine may increase the anticoagulant activities of Bivalirudin.
NaproxenNaproxen may increase the anticoagulant activities of Bivalirudin.
NCX 4016NCX 4016 may increase the anticoagulant activities of Bivalirudin.
NefazodoneThe serum concentration of Nefazodone can be increased when it is combined with Bivalirudin.
NepafenacNepafenac may increase the anticoagulant activities of Bivalirudin.
Niflumic AcidNiflumic Acid may increase the anticoagulant activities of Bivalirudin.
NimesulideNimesulide may increase the anticoagulant activities of Bivalirudin.
NintedanibThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Nintedanib.
NorethisteroneThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Norethisterone.
NortriptylineThe serum concentration of Nortriptyline can be increased when it is combined with Bivalirudin.
ObinutuzumabThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Obinutuzumab.
OlopatadineOlopatadine may increase the anticoagulant activities of Bivalirudin.
OlsalazineOlsalazine may increase the anticoagulant activities of Bivalirudin.
Omacetaxine mepesuccinateThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Omacetaxine mepesuccinate.
Omega-3 fatty acidsOmega-3 fatty acids may increase the anticoagulant activities of Bivalirudin.
OrgoteinOrgotein may increase the anticoagulant activities of Bivalirudin.
OtamixabanBivalirudin may increase the anticoagulant activities of Otamixaban.
OxaprozinOxaprozin may increase the anticoagulant activities of Bivalirudin.
OxyphenbutazoneOxyphenbutazone may increase the anticoagulant activities of Bivalirudin.
ParecoxibParecoxib may increase the anticoagulant activities of Bivalirudin.
ParnaparinParnaparin may increase the anticoagulant activities of Bivalirudin.
Pentosan PolysulfatePentosan Polysulfate may increase the anticoagulant activities of Bivalirudin.
PentoxifyllinePentoxifylline may increase the anticoagulant activities of Bivalirudin.
PethidineThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Pethidine.
PhenindioneBivalirudin may increase the anticoagulant activities of Phenindione.
PhenprocoumonBivalirudin may increase the anticoagulant activities of Phenprocoumon.
PhenylbutazonePhenylbutazone may increase the anticoagulant activities of Bivalirudin.
PimecrolimusPimecrolimus may increase the anticoagulant activities of Bivalirudin.
PimozideThe serum concentration of Pimozide can be increased when it is combined with Bivalirudin.
PirfenidonePirfenidone may increase the anticoagulant activities of Bivalirudin.
PiroxicamPiroxicam may increase the anticoagulant activities of Bivalirudin.
PlasminPlasmin may increase the anticoagulant activities of Bivalirudin.
Polyestradiol phosphatePolyestradiol phosphate may decrease the anticoagulant activities of Bivalirudin.
PrasugrelPrasugrel may increase the anticoagulant activities of Bivalirudin.
ProgesteroneThe therapeutic efficacy of Bivalirudin can be decreased when used in combination with Progesterone.
PropacetamolPropacetamol may increase the anticoagulant activities of Bivalirudin.
Protein CBivalirudin may increase the anticoagulant activities of Protein C.
ProtocatechualdehydeBivalirudin may increase the anticoagulant activities of Protocatechualdehyde.
ProtriptylineThe serum concentration of Protriptyline can be increased when it is combined with Bivalirudin.
PTC299PTC299 may increase the anticoagulant activities of Bivalirudin.
QuinestrolQuinestrol may decrease the anticoagulant activities of Bivalirudin.
ResveratrolResveratrol may increase the anticoagulant activities of Bivalirudin.
ReteplaseReteplase may increase the anticoagulant activities of Bivalirudin.
ReviparinBivalirudin may increase the anticoagulant activities of Reviparin.
RidogrelRidogrel may increase the anticoagulant activities of Bivalirudin.
RiociguatThe serum concentration of Riociguat can be increased when it is combined with Bivalirudin.
RivaroxabanBivalirudin may increase the anticoagulant activities of Rivaroxaban.
RofecoxibRofecoxib may increase the anticoagulant activities of Bivalirudin.
RosiglitazoneRosiglitazone may increase the anticoagulant activities of Bivalirudin.
RosuvastatinThe serum concentration of Rosuvastatin can be increased when it is combined with Bivalirudin.
SalicylamideSalicylamide may increase the anticoagulant activities of Bivalirudin.
Salicylic acidSalicylic acid may increase the anticoagulant activities of Bivalirudin.
SalsalateSalsalate may increase the anticoagulant activities of Bivalirudin.
SCH-530348SCH-530348 may increase the anticoagulant activities of Bivalirudin.
SelexipagSelexipag may increase the anticoagulant activities of Bivalirudin.
SeratrodastSeratrodast may increase the anticoagulant activities of Bivalirudin.
SevofluraneSevoflurane may increase the anticoagulant activities of Bivalirudin.
SildenafilThe serum concentration of Sildenafil can be increased when it is combined with Bivalirudin.
SimeprevirThe serum concentration of Simeprevir can be increased when it is combined with Bivalirudin.
SimvastatinThe serum concentration of Simvastatin can be increased when it is combined with Bivalirudin.
SRT501SRT501 may increase the anticoagulant activities of Bivalirudin.
St. John's WortThe metabolism of Bivalirudin can be increased when combined with St. John's Wort.
StreptokinaseStreptokinase may increase the anticoagulant activities of Bivalirudin.
SugammadexSugammadex may increase the anticoagulant activities of Bivalirudin.
SulfasalazineSulfasalazine may increase the anticoagulant activities of Bivalirudin.
SulindacSulindac may increase the anticoagulant activities of Bivalirudin.
SulodexideBivalirudin may increase the anticoagulant activities of Sulodexide.
SuprofenSuprofen may increase the anticoagulant activities of Bivalirudin.
Synthetic Conjugated Estrogens, ASynthetic Conjugated Estrogens, A may decrease the anticoagulant activities of Bivalirudin.
Synthetic Conjugated Estrogens, BSynthetic Conjugated Estrogens, B may decrease the anticoagulant activities of Bivalirudin.
TacrolimusThe metabolism of Tacrolimus can be decreased when combined with Bivalirudin.
TemsirolimusThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Temsirolimus.
TenecteplaseTenecteplase may increase the anticoagulant activities of Bivalirudin.
TenoxicamTenoxicam may increase the anticoagulant activities of Bivalirudin.
TepoxalinTepoxalin may increase the anticoagulant activities of Bivalirudin.
TeriflunomideTeriflunomide may increase the anticoagulant activities of Bivalirudin.
TesmilifeneTesmilifene may increase the anticoagulant activities of Bivalirudin.
TheophyllineThe serum concentration of Theophylline can be decreased when it is combined with Bivalirudin.
TianeptineThe serum concentration of Tianeptine can be increased when it is combined with Bivalirudin.
Tiaprofenic acidTiaprofenic acid may increase the anticoagulant activities of Bivalirudin.
TiboloneTibolone may increase the anticoagulant activities of Bivalirudin.
TicagrelorTicagrelor may increase the anticoagulant activities of Bivalirudin.
TiclopidineTiclopidine may increase the anticoagulant activities of Bivalirudin.
TinzaparinTinzaparin may increase the anticoagulant activities of Bivalirudin.
TipranavirThe serum concentration of Bivalirudin can be decreased when it is combined with Tipranavir.
TirofibanTirofiban may increase the anticoagulant activities of Bivalirudin.
Tolfenamic AcidTolfenamic Acid may increase the anticoagulant activities of Bivalirudin.
TolmetinTolmetin may increase the anticoagulant activities of Bivalirudin.
TositumomabThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Tositumomab.
TranilastTranilast may increase the anticoagulant activities of Bivalirudin.
TrapidilTrapidil may increase the anticoagulant activities of Bivalirudin.
TreprostinilTreprostinil may increase the anticoagulant activities of Bivalirudin.
TreprostinilThe risk or severity of adverse effects can be increased when Bivalirudin is combined with Treprostinil.
TriazolamThe serum concentration of Triazolam can be increased when it is combined with Bivalirudin.
TriflusalTriflusal may increase the anticoagulant activities of Bivalirudin.
TrimipramineThe serum concentration of Trimipramine can be increased when it is combined with Bivalirudin.
Trisalicylate-cholineTrisalicylate-choline may increase the anticoagulant activities of Bivalirudin.
UrokinaseUrokinase may increase the anticoagulant activities of Bivalirudin.
ValdecoxibValdecoxib may increase the anticoagulant activities of Bivalirudin.
Vitamin EVitamin E may increase the anticoagulant activities of Bivalirudin.
VorapaxarThe risk or severity of adverse effects can be increased when Vorapaxar is combined with Bivalirudin.
WarfarinBivalirudin may increase the anticoagulant activities of Warfarin.
XimelagatranBivalirudin may increase the anticoagulant activities of Ximelagatran.
ZaltoprofenZaltoprofen may increase the anticoagulant activities of Bivalirudin.
ZeranolZeranol may decrease the anticoagulant activities of Bivalirudin.
ZidovudineThe serum concentration of Zidovudine can be decreased when it is combined with Bivalirudin.
ZileutonZileuton may increase the anticoagulant activities of Bivalirudin.
ZomepiracZomepirac may increase the anticoagulant activities of Bivalirudin.
Food Interactions
  • Dan shen, dong quai, evening primrose oil, gingko, policosanol, willow bark
  • Echinacea

Targets

Kind
Protein
Organism
Human
Pharmacological action
yes
Actions
inhibitor
General Function:
Thrombospondin receptor activity
Specific Function:
Thrombin, which cleaves bonds after Arg and Lys, converts fibrinogen to fibrin and activates factors V, VII, VIII, XIII, and, in complex with thrombomodulin, protein C. Functions in blood homeostasis, inflammation and wound healing.
Gene Name:
F2
Uniprot ID:
P00734
Molecular Weight:
70036.295 Da
References
  1. Scatena R: Bivalirudin: a new generation antithrombotic drug. Expert Opin Investig Drugs. 2000 May;9(5):1119-27. [PubMed:11060732 ]
  2. Bates ER: Bivalirudin for percutaneous coronary intervention and in acute coronary syndromes. Curr Cardiol Rep. 2001 Sep;3(5):348-54. [PubMed:11504570 ]
  3. Gladwell TD: Bivalirudin: a direct thrombin inhibitor. Clin Ther. 2002 Jan;24(1):38-58. [PubMed:11833835 ]
  4. Kleiman NS, Klem J, Fernandes LS, Rubin H, Challa S, Solomon S, Maresh K, Arora U, Klem E, Buergler J, Mathew S, Browning A, DeLao T: Pharmacodynamic profile of the direct thrombin antagonist bivalirudin given in combination with the glycoprotein IIb/IIIa antagonist eptifibatide. Am Heart J. 2002 Apr;143(4):585-93. [PubMed:11923794 ]
  5. Carswell CI, Plosker GL: Bivalirudin: a review of its potential place in the management of acute coronary syndromes. Drugs. 2002;62(5):841-70. [PubMed:11929334 ]
  6. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [PubMed:11752352 ]

Enzymes

Kind
Protein
Organism
Human
Pharmacological action
unknown
Actions
inhibitor
General Function:
Peroxidase activity
Specific Function:
Part of the host defense system of polymorphonuclear leukocytes. It is responsible for microbicidal activity against a wide range of organisms. In the stimulated PMN, MPO catalyzes the production of hypohalous acids, primarily hypochlorous acid in physiologic situations, and other toxic intermediates that greatly enhance PMN microbicidal activity.
Gene Name:
MPO
Uniprot ID:
P05164
Molecular Weight:
83867.71 Da
References
  1. Rudolph V, Rudolph TK, Schopfer FJ, Bonacci G, Lau D, Szocs K, Klinke A, Meinertz T, Freeman BA, Baldus S: Bivalirudin decreases NO bioavailability by vascular immobilization of myeloperoxidase. J Pharmacol Exp Ther. 2008 Nov;327(2):324-31. doi: 10.1124/jpet.108.142414. Epub 2008 Aug 13. [PubMed:18701766 ]
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Drug created on June 13, 2005 07:24 / Updated on September 27, 2016 03:40