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# Ticagrelor
## Overview
Ticagrelor is a direct-acting, reversibly binding P2Y12 receptor antagonist that inhibits platelet activation and aggregation.
## Primary Indications
* Inhibition of thrombotic events (myocardial infarction, stroke, or cardiovascular death) in patients with acute coronary syndrome (ACS) or a history of myocardial infarction.
## Adult Dosing
* **ACS:** 180 mg orally as a single loading dose, followed by 90 mg orally twice daily.
* **Post-MI (at least 1 year after ACS event):** 60 mg orally twice daily.
## Pediatric Dosing
No established pediatric dosing.
## Dose Adjustments
No dose adjustment is recommended for mild to moderate hepatic or renal impairment. Use with caution in severe hepatic impairment.
## Contraindications
* Active pathological bleeding.
* History of transient ischemic attack (TIA) or stroke.
* Concomitant use with strong CYP3A4 inhibitors.
* Known hypersensitivity to ticagrelor.
## Adverse Effects
* **Most Common:** Bleeding (including life-threatening), dyspnea, bradycardia, ventricular pauses.
* **Serious:** Major bleeding, intracranial hemorrhage, gastrointestinal bleeding, symptomatic bradycardia.
## Key Drug Interactions
* **Strong CYP3A4 Inhibitors (e.g., ketoconazole, clarithromycin):** Increased ticagrelor exposure; avoid coadministration.
* **Strong CYP3A4 Inducers (e.g., rifampin, carbamazepine):** Decreased ticagrelor exposure; use with caution.
* **Statins:** Potential for increased exposure of certain statins (e.g., simvastatin, atorvastatin) metabolized by CYP3A4; consider dose reduction of statin if indicated.
* **Other Antiplatelets/Anticoagulants:** Increased risk of bleeding.
## Monitoring
* Monitor for signs and symptoms of bleeding.
* Monitor for bradycardia.
## Clinical Pearls
* Ticagrelor's onset of action is rapid.
* Patients should be advised to continue therapy for the duration recommended by their physician, as premature discontinuation increases the risk of thrombotic events.
* If a dose is missed, the patient should take the next dose at the scheduled time and not double the dose.
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*This information is intended for clinical use and does not replace consulting the official prescribing information and local protocols. Always verify current drug information before making clinical decisions.*
