Please check your internet connection and try again.
# Ticagrelor (Brilinta)
## Overview
Ticagrelor is an orally administered, direct-acting P2Y12 receptor antagonist that reversibly inhibits platelet aggregation.
## Primary Indications
* Reduction of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) or a history of myocardial infarction (MI).
## Adult Dosing
* **ACS:**
* Loading dose: 180 mg orally once.
* Maintenance dose: 90 mg orally twice daily.
* **History of MI (1 year post-ACS/PCI or >1 year after ACS/PCI):**
* 90 mg orally twice daily.
* **Note:** Dosing may be extended beyond 12 months in select patients based on individual risk assessment and local protocols.
## Pediatric Dosing
* Ticagrelor is not recommended for use in pediatric patients. Safety and efficacy have not been established.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is required.
* **Hepatic Impairment:** No dose adjustment is required for mild to moderate hepatic impairment. Use with caution in severe hepatic impairment.
## Contraindications
* Active pathological bleeding (e.g., intracranial hemorrhage, active gastrointestinal bleeding).
* History of intracranial hemorrhage.
* Known hypersensitivity to ticagrelor or any component of the formulation.
## Adverse Effects
* **Most Common:** Bleeding (including life-threatening and fatal), dyspnea, bradycardia.
* **Serious:** Serious bleeding events, ventricular pauses.
* **Other:** Hypertension, cough, contusion.
## Key Drug Interactions
* **CYP3A4 Substrates:** Ticagrelor is a moderate inhibitor of CYP3A4. Concomitant use with potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin) may increase ticagrelor exposure.
* **CYP3A4 Inducers:** Concomitant use with potent CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin) may decrease ticagrelor exposure.
* **Strong CYP3A4 Inhibitors (e.g., Ritonavir):** May increase ticagrelor plasma concentrations; monitor for bleeding.
* **Statins:** Ticagrelor can increase the AUC of some statins (e.g., simvastatin, atorvastatin); consider maximum statin doses or alternative statins.
* **Aspirin:** Can be used concomitantly for dual antiplatelet therapy.
* **Anticoagulants (e.g., Warfarin, Heparin):** Increased risk of bleeding. Concomitant use should be carefully considered and monitored.
## Monitoring
* Monitor for signs and symptoms of bleeding.
* Monitor for bradycardia; assess if clinical intervention is warranted.
* Evaluate adherence to medication regimen.
## Clinical Pearls
* Ticagrelor has a faster onset and offset of action compared to clopidogrel.
* Dyspnea is a common side effect and may require discontinuation if severe.
* Discontinue ticagrelor 5 days prior to elective surgery if possible, but weigh the risk of thrombotic events against the risk of bleeding.
* Ticagrelor should be taken for at least 12 months in ACS patients, unless contraindicated.
***
*Disclaimer: This information is intended for healthcare professionals and does not replace the need to consult the official prescribing information and relevant literature. Always verify current drug information before making clinical decisions.*
