Please check your internet connection and try again.
# Ticagrelor
## Overview
Ticagrelor is a direct-acting, reversible P2Y12 platelet inhibitor. It is used to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) or a history of myocardial infarction (MI).
## Primary Indications
* Acute Coronary Syndrome (ACS)
* Secondary prevention in patients with a history of myocardial infarction (MI)
## Adult Dosing
* **ACS:** Loading dose: 180 mg orally once. Maintenance dose: 90 mg orally twice daily.
* **Post-MI (history of MI):** 60 mg orally twice daily.
* **Note:** For ACS, the 90 mg twice daily dose is typically continued for at least 12 months, or longer based on individual risk assessment and local guidelines. Following completion of P2H treatment, ticagrelor 60 mg twice daily may be considered for secondary prevention.
## Pediatric Dosing
* No established pediatric dosing.
## Dose Adjustments
* **Hepatic Impairment:** No dose adjustment needed in mild to moderate hepatic impairment. Use with caution in severe hepatic impairment.
* **Renal Impairment:** No dose adjustment needed in mild to moderate renal impairment. Use with caution in severe renal impairment.
## Contraindications
* Active pathological bleeding (e.g., intracranial hemorrhage, gastrointestinal bleeding).
* History of transient ischemic attack (TIA) or stroke.
* Concomitant use of strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir).
* Known hypersensitivity to ticagrelor or any of its excipients.
## Adverse Effects
* **Common:** Dyspnea, bleeding (including fatal and life-threatening), bruising.
* **Serious:** Severe bleeding, bradyarrhythmia, increased serum creatinine, uric acid elevation.
## Key Drug Interactions
* **CYP3A4 Substrates:** Ticagrelor is a moderate inhibitor of CYP3A4. Concomitant use with strong CYP3A4 substrates may increase exposure to these drugs.
* **CYP3A4 Inducers:** May decrease ticagrelor plasma concentrations.
* **Aspirin:** Concomitant use increases bleeding risk. When used in ACS, aspirin is typically given along with ticagrelor. For secondary prevention (60 mg dose), the optimal duration of co-administration with aspirin is not well established and should be individualized.
* **Other Antiplatelets/Anticoagulants:** Increased risk of bleeding.
## Monitoring
* Monitor for signs and symptoms of bleeding.
* Monitor renal function and serum uric acid levels periodically.
* Assess for dyspnea.
## Clinical Pearls
* Ticagrelor is a reversible P2Y12 inhibitor, unlike clopidogrel and prasugrel which are irreversible.
* Dyspnea is a common side effect and may resolve with continued therapy or dose reduction.
* Discontinuation of ticagrelor should be avoided if possible due to increased risk of thrombotic events.
* Use with caution in patients with a history of gout or hyperuricemia.
**Disclaimer:** This information is intended for clinical use and is a summary. Always consult the official prescribing information and current clinical guidelines for complete details and to ensure patient-specific appropriateness.
