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# Ticagrelor (Brilinta)
## Overview
Ticagrelor is an orally administered, direct-acting, reversible P2Y12 platelet inhibitor. It is used to prevent thrombotic events.
## Primary Indications
* Reduction of thrombotic cardiovascular events (including myocardial infarction and stroke) in patients with acute coronary syndrome (ACS) or a history of myocardial infarction (MI).
* Prevention of recurrent MI and stroke in patients with established atherosclerotic cardiovascular disease (ASCVD).
## Adult Dosing
* **ACS:** Loading dose of 180 mg orally once, followed by 90 mg orally twice daily for at least 12 months. After 12 months, consider 60 mg orally twice daily for maintenance.
* **Established ASCVD:** 60 mg orally twice daily.
## Pediatric Dosing
* Dosing in pediatric patients is not established.
## Dose Adjustments
* No specific dose adjustments are recommended for patients with hepatic or renal impairment.
## Contraindications
* Active pathological bleeding.
* History of intracranial hemorrhage.
* Hypersensitivity to ticagrelor or any component of the formulation.
## Adverse Effects
* **Common:** Dyspnea, bradycardia, ventricular pauses, increased serum creatinine, hyperuricemia.
* **Serious:** Bleeding (including gastrointestinal, genitourinary, and intracranial hemorrhage), anaphylaxis.
## Key Drug Interactions
* **CYP3A4 Substrates:** Ticagrelor is a moderate inhibitor of CYP3A4. Avoid coadministration with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) and strong CYP3A4 inducers (e.g., rifampin). Exercise caution with other CYP3A4 substrates (e.g., simvastatin, atorvastatin), as ticagrelor can increase their concentrations.
* **Other Antiplatelet Agents/Anticoagulants:** Increased risk of bleeding. Use with caution and monitor closely.
* **Digoxin:** Ticagrelor may increase digoxin concentrations. Monitor digoxin levels.
## Monitoring
* Monitor for signs and symptoms of bleeding.
* Monitor renal function and uric acid levels, especially in patients with a history of hyperuricemia or gout.
* Monitor heart rate for bradycardia.
## Clinical Pearls
* Ticagrelor is a reversible P2Y12 inhibitor, unlike clopidogrel.
* Dyspnea is a common side effect and is usually transient. It is not typically a contraindication to continuing therapy unless severe.
* Loading dose of aspirin (75-325 mg) is recommended with ticagrelor for ACS. Maintenance aspirin dose should be low (75-100 mg).
* For patients on ticagrelor who require elective surgery, a discontinuation interval of at least 5 days prior to the procedure is generally recommended, but individual risk-benefit assessment is crucial.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to verify the information presented.*
