Please check your internet connection and try again.
## Ticagrelor (Brilinta)
### Overview
Ticagrelor is a direct-acting, reversible P2Y12 platelet inhibitor used to reduce the rate of thrombotic cardiovascular events.
### Primary Indications
* In combination with aspirin, for patients with a history of myocardial infarction (MI) to reduce the rate of cardiovascular death, MI, and stroke.
* In combination with aspirin, for the prevention of thrombotic events in patients who have undergone percutaneous coronary intervention (PCI).
### Adult Dosing
* **Loading Dose:** 180 mg orally once.
* **Maintenance Dose:** 90 mg orally twice daily.
* For patients who have undergone PCI, the dose may be reduced to 60 mg orally twice daily after at least 12 months of treatment with 90 mg twice daily, provided they are not at high risk for stent thrombosis or other major adverse cardiovascular events.
* Maximum dose: Not applicable for maintenance therapy; loading dose is a single dose.
### Pediatric Dosing
Ticagrelor is not recommended in pediatric patients due to a lack of data.
### Dose Adjustments
No dose adjustments are necessary for renal impairment.
For mild to moderate hepatic impairment, no dose adjustment is needed. Ticagrelor has not been studied in severe hepatic impairment.
### Contraindications
* Active serious bleeding.
* History of transient ischemic attack (TIA) or stroke.
* Known hypersensitivity to ticagrelor or any of its components.
### Adverse Effects
* **Most Common:** Bleeding (including fatal and life-threatening), dyspnea.
* **Other Significant:** Ventricular pauses, bradyarrhythmia, increased serum creatinine, hyperuricemia, angina pectoris.
### Key Drug Interactions
* **CYP3A4 Substrates:** Ticagrelor is a moderate inhibitor of CYP3A4. Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin) can increase ticagrelor exposure. Avoid concomitant use of strong CYP3A4 inhibitors.
* **CYP3A4 Inducers:** Concomitant use with strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin) can decrease ticagrelor exposure and efficacy. Avoid concomitant use.
* **Other Antiplatelets/Anticoagulants:** Increased risk of bleeding. Use with caution and monitor closely.
### Monitoring
* Monitor for signs and symptoms of bleeding.
* Monitor for new or worsening dyspnea.
* Periodic assessment of renal function and uric acid levels may be considered.
### Clinical Pearls
* Ticagrelor is a direct-acting, reversible P2Y12 inhibitor, meaning its effect can be reversed upon discontinuation, unlike clopidogrel.
* Aspirin dose should generally not exceed 100 mg daily when used with ticagrelor, as higher doses may increase bleeding risk without additional benefit.
* Patients should be advised to report any signs of bleeding or unusual bruising.
* Discontinuation of ticagrelor should be avoided if possible, especially during the initial treatment period, as it increases the risk of thrombotic events.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.*
