Please check your internet connection and try again.
# Ticagrelor
## Overview
Ticagrelor is a direct-acting, reversible P2Y12 platelet inhibitor.
## Primary Indications
* In combination with aspirin, for the reduction of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) or a history of myocardial infarction (MI).
* In combination with aspirin, for the prevention of stent thrombosis in patients with ACS or a history of MI who have undergone percutaneous coronary intervention (PCI).
## Adult Dosing
* **Loading Dose:** 180 mg orally once.
* **Maintenance Dose:** 90 mg orally twice daily.
* **ACS:** Continue for at least 12 months. Consider discontinuation based on individual risk factors and clinical judgment.
* **Prevention of Stent Thrombosis:** Duration is individualized.
## Pediatric Dosing
* Ticagrelor is not approved for use in pediatric patients.
## Dose Adjustments
* No dose adjustments are typically required based on age, sex, or renal impairment.
* **Hepatic Impairment:** Use with caution in moderate to severe hepatic impairment. Data is limited.
## Contraindications
* Active pathological bleeding (e.g., peptic ulcer, intracranial hemorrhage).
* History of transient ischemic attack (TIA) or stroke.
* Hypersensitivity to ticagrelor or any of its excipients.
## Adverse Effects
* **Most Common:** Dyspnea, bleeding (including life-threatening and fatal), bradycardia, increased serum creatinine.
* **Serious:** Severe bleeding, ventricular pauses, angioedema.
## Key Drug Interactions
* **CYP3A4 Inhibitors/Inducers:** Ticagrelor is a substrate of CYP3A4. Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) can increase ticagrelor exposure. Concomitant use with strong CYP3A4 inducers (e.g., rifampin, carbamazepine) can decrease ticagrelor exposure.
* **Aspirin:** Concomitant use increases bleeding risk.
* **Other Antiplatelets/Anticoagulants:** Increased risk of bleeding.
* **Statins:** Increased risk of hypercholesterolemia.
## Monitoring
* Monitor for signs and symptoms of bleeding.
* Monitor for dyspnea.
* Monitor serum creatinine and potassium, especially in patients with renal or hepatic impairment.
* Monitor heart rate for bradycardia.
## Clinical Pearls
* Ticagrelor is a reversible P2Y12 inhibitor, meaning its effect can be reversed relatively quickly upon discontinuation, which may be beneficial in patients requiring urgent surgery.
* Dyspnea is a common side effect and is usually mild and transient, but should be evaluated.
* Avoid concomitant use with strong CYP3A4 inhibitors or inducers unless absolutely necessary.
* Discontinuation of ticagrelor prematurely increases the risk of thrombotic events.
***
*This information is intended for healthcare professionals and does not replace a thorough review of the current prescribing information. Always consult the most recent product monograph or other relevant clinical resources before initiating or modifying therapy.*
