Ticagrelor

Class
Antiplatelets
Subclass
P2Y12 inhibitors
Substance name
Ticagrelor
Brand names
Brilinta®
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment
Cardiovascular mortality in patients with myocardial infarction
Loading: 180 mg PO once
Maintenance: 90 mg PO BID for 1 year
Prevention
Cardiovascular mortality in patients with acute coronary syndromes
Loading: 180 mg PO once
Maintenance: 90 mg PO BID for 1 year followed by 60 mg twice daily thereafter
Stroke in patients with AISNIH Stroke Scale score ≤ 5
Loading: 180 mg PO once
Maintenance: 90 mg PO BID a duration of up to 30 days
TIA
Loading: 180 mg PO once
Maintenance: 90 mg PO BID a duration of up to 30 days
Indications for use
Labeled indications
Adults
Treatment of cardiovascular mortality in patients with myocardial infarction
Treatment of coronary artery disease (prevention of first myocardial infarction and first stroke)
Prevention of cardiovascular mortality in patients with acute coronary syndromes
Prevention of stroke in patients with AIS (NIH Stroke Scale score ≤ 5)
Prevention of TIA
Safety risks
Boxed warnings
Exacerbation of bleeding
Contraindications
Hypersensitivity to ticagrelor or any of its components
Warnings and precautions
Cardiac arrhythmias, bradycardia
Use caution in patients with a history of sick sinus syndrome, second or third degree AV block, or syncope.
Dyspnea
Maintain a high level of suspicion, as mild to moderate intensity dyspnea has been observed in patients treated with ticagrelor.
Exacerbation of central sleep apnea, Cheyne-Stokes respirations
Use extreme caution in patients with pre-existing central sleep apnea.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
Use acceptable. No dose adjustment required.
Renal replacement therapy
Any modality
Use acceptable. No dose adjustment required.
Hepatic impairment
Child-Pugh A (mild)
Use acceptable. No dose adjustment required. Monitor for toxicity.
Child-Pugh B (moderate)
Use with caution. Monitor for toxicity. - Carefully weigh the risks versus the benefits of treatment, considering the probable increase in exposure to ticagrelor.
Child-Pugh C (severe)
Do not use.
Pregnancy and breastfeeding
Pregnancy
All trimesters
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. AU and UK: Use is not recommended.
US: Use during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Furthermore, ticagrelor should be used with extreme caution near term and during labor and obstetric delivery because of the possibility of maternal postpartum hemorrhage.
tial risk to the fetus.
Breastfeeding
Consider alternative agents that may be safer.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
Dyspnea
Common 1-10%
AF, bleeding, bradycardia, hypertension, hypotension, back pain, chest pain, cough, diarrhea, dizziness, fatigue, headache, nausea, syncope
Uncommon < 1%
Gynecomastia, intracranial hemorrhage, intracranial hemorrhage, ↑ serum uric acid
Unknown frequency
Atrioventricular block, angioedema, apnea, cheyne-Stokes breathing, skin rash, thrombotic thrombocytopenic purpura
Interactions
Drug(s)
Check Interactions
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