AMENDMENT NO. 1 TO AMENDED AND RESTATED DISTRIBUTION AGREEMENT

Exhibit 10.3

The Medicines Company
requests that the marked portions of the agreement be granted confidential treatment under
Rule 24b-2 of the Securities Exchange Act of 1934.

AMENDMENT NO. 1 TO
AMENDED AND RESTATED DISTRIBUTION AGREEMENT

     This is Amendment No. 1 (this “ Amendment ”) to the Amended and Restated Distribution Agreement, effective as of February 28, 2007, between The Medicines Company , a Delaware corporation with offices at 8 Campus Drive, Parsippany, NJ 07054 (“ TMC ”), and Integrated Commercialization Solutions, Inc., a California corporation with offices at 3101 Gaylord Parkway, Frisco, TX 75034 (the “ Distributor ”). This Amendment is effective as of November 7, 2007 (the “Effective Date”).

Recitals

     WHEREAS, TMC and Distributor are parties to the Amended and Restated Distribution Agreement, effective as of February 28, 2007 (the “ Agreement ”), under which Distributor distributes TMC’s product ANGIOMAX® (bivalirudin); and

     WHEREAS, the parties now desire to amend the Agreement as more fully set forth herein;

     NOW, THEREFORE, in consideration of the premises and the covenants and agreements contained herein, and for other good and valuable consideration, the receipt of which are hereby acknowledged, the parties agree as follows:

     1.  Defined Terms . Capitalized terms that are not defined in this Amendment shall have the meanings given to them in the Agreement.

     2.  Schedule C . Schedule C to the Agreement is hereby deleted and replaced in its entirety with the attached revised Schedule C.

     3.  Schedule D . Schedule D to the Agreement is hereby deleted and replaced in its entirety with the attached revised Schedule D.

     4.  Effect of Amendment . Except as expressly provided in this Amendment, the Agreement will continue in full force according to its terms. If there is any conflict between the Agreement and any provision of this Amendment, this Amendment will control.

     IN WITNESS WHEREOF, the parties have executed this Amendment as of the Effective Date.

REVISED SCHEDULE C

Data Transfer and Reporting

Crystal Reports :

Daily Inventory Report

Daily Inventory Summary Report

Daily Sales Report

Daily Sales Summary Report

867 Collection and Report Conversion (up to 5 Wholesalers)

FTP Reports

Weekly Chargeback Reports

Daily Sales and Returns Report

Weekly Service Level Report

REVISED SCHEDULE D