Ticagre%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252528ticagrelor%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252529

# Ticagrelor ## Overview Ticagrelor is a direct-acting, reversible P2Y12 platelet inhibitor. ## Primary Indications * Reduction of thrombotic cardiovascular events in patients with a history of myocardial infarction (MI) or with acute coronary syndrome (ACS). ## Adult Dosing * **Acute Coronary Syndrome (ACS):** * A **loading dose of 180 mg orally once daily** for the first dose. * Followed by **90 mg orally twice daily**. * **Established Myocardial Infarction (MI):** * **90 mg orally twice daily**. * **Duration:** Generally for at least 12 months. Duration may be extended based on individual risk factors and bleeding risk. ## Pediatric Dosing * There is no established pediatric dosing. Ticagrelor is not approved for use in pediatric patients. ## Dose Adjustments * No dose adjustment is required for renal impairment. * No dose adjustment is required for mild to moderate hepatic impairment. Use with caution in severe hepatic impairment. ## Contraindications * Concomitant use with strong CYP3A4 inhibitors. * Active pathological bleeding. * History of intracerebral hemorrhage. ## Adverse Effects * **Most Common:** Dyspnea, bradycardia, ventricular pauses, hyperkalemia, bleeding (major, minor, gastrointestinal). * **Serious:** Serious bleeding, clinically significant bradycardia. ## Key Drug Interactions * **CYP3A4 Substrates:** Ticagrelor is a moderate inhibitor of CYP3A4. Concomitant use with drugs primarily metabolized by CYP3A4 (e.g., simvastatin, atorvastatin, cyclosporine) may increase their plasma concentrations. Avoid strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin). * **CYP2C19 Inhibitors/Inducers:** Ticagrelor is a substrate of CYP2C19. Strong CYP2C19 inhibitors (e.g., omeprazole, esomeprazole) may decrease ticagrelor exposure. Strong CYP2C19 inducers (e.g., rifampin) may increase ticagrelor exposure. * **Other Antiplatelets/Anticoagulants:** Increased risk of bleeding. Use with caution and monitor for bleeding. * **NSAIDs:** Increased risk of bleeding. * **Aspirin:** Generally used in combination with aspirin for ACS/MI, but increases bleeding risk. ## Monitoring * Monitor for signs and symptoms of bleeding. * Monitor for dyspnea. * Monitor ECG for bradycardia, especially in patients with risk factors. * Monitor serum potassium in patients with risk factors for hyperkalemia. ## Clinical Pearls * Ticagrelor is a reversible inhibitor, unlike clopidogrel. * Dosing is twice daily, which is different from clopidogrel and prasugrel. * Dyspnea is a common side effect and is generally not an indication to discontinue the drug unless severe. * The bleeding risk needs to be carefully balanced against the benefit of reducing thrombotic events. * Dose of aspirin should be limited to 100 mg daily when used concurrently with ticagrelor, as higher doses may increase bleeding risk without adding significant benefit. --- *This information is for educational purposes and does not substitute for professional medical advice. Always consult the current prescribing information and a healthcare professional before making any decisions related to medication use.*