Please check your internet connection and try again.
# Ticagrelor (Brilinta)
## Overview
Ticagrelor is an oral, direct-acting, reversible P2Y12 platelet inhibitor. It is part of a class of drugs known as antiplatelet agents.
## Primary Indications
* Reduction of thrombotic cardiovascular events in patients with a history of myocardial infarction (MI).
* In combination with aspirin, for the prevention of thrombotic events in patients with acute coronary syndrome (ACS).
## Adult Dosing
* **Post-MI:** 90 mg orally twice daily for at least 12 months. In patients who are at high risk for thrombotic events, consider continuing therapy beyond 12 months.
* **ACS:** 180 mg orally as a single loading dose, followed by 90 mg twice daily. Treatment duration is typically 12 months or until the patient has undergone revascularization.
* **Maintenance Dose Consideration:** For patients on ticagrelor 90 mg twice daily who are at increased risk of bleeding and have not had a recent ACS or stroke, a lower maintenance dose of 60 mg twice daily may be considered after 12 months of treatment.
## Pediatric Dosing
Dosing in pediatric patients is not established.
## Dose Adjustments
No dose adjustment is necessary based on renal or hepatic impairment. However, caution is advised in patients with severe hepatic impairment.
## Contraindications
* Active pathological bleeding.
* History of intracranial hemorrhage.
* Known hypersensitivity to ticagrelor or any of its components.
## Adverse Effects
* **Common:** Dyspnea, bleeding (including life-threatening and fatal bleeding), bradycardia, syncope, dizziness, headache, diarrhea, nausea, rash.
* **Serious:** Significant bleeding events, severe bradyarrhythmias.
## Key Drug Interactions
* **CYP3A4 Substrates:** Ticagrelor is a moderate inhibitor of CYP3A4. Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir) may increase ticagrelor exposure. Concomitant use with strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin) may decrease ticagrelor exposure.
* **CYP3A4 Substrates:** Ticagrelor can increase the plasma concentration of CYP3A4 substrates (e.g., simvastatin, atorvastatin). Use with high-dose statins requires caution.
* **Aspirin:** Prolonged use of aspirin with ticagrelor can increase bleeding risk. Maintain at the lowest effective dose.
* **Anticoagulants (e.g., warfarin, heparin, direct oral anticoagulants):** Concomitant use increases the risk of bleeding.
## Monitoring
* **Bleeding:** Monitor closely for signs and symptoms of bleeding.
* **Heart Rate:** Ticagrelor can cause asymptomatic bradycardia.
## Clinical Pearls
* Ticagrelor is a reversible P2Y12 inhibitor, meaning its effects are more rapidly reversible than clopidogrel.
* Dyspnea is a common side effect and does not necessarily indicate cardiac dysfunction.
* When switching from or to other P2Y12 inhibitors, ensure no gap in therapy.
* Aspirin should be continued indefinitely in patients treated for ACS unless contraindicated.
***
*This information is intended for healthcare professionals and does not replace current prescribing information. Always consult the official product monograph and relevant clinical guidelines for the most up-to-date and comprehensive details.*
