See Supplemental Patient Information
- Ticagrelor therapy can increase the risk of bleeding. Patients with history of bleeding disorders, those taking concomitant use of drugs that increase bleeding risk, those undergoing invasive procedures and older patients are at higher risk
- Discontinue ticagrelor five days prior to any surgery and suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, PCI, CABG, or other surgical procedures [US Black Box Warning]
- Manage bleeding without discontinuing ticagrelor therapy as stopping it may increases the risk of subsequent cardiovascular events [US Black Box Warning]
- Avoid maintenance dose of aspirin above 100 mg as it will reduce the effectiveness ticagrelor. Use 75-100 mg/day of aspirin after initial loading dose [US Black Box Warning]
- Hepatic impairment may increase the exposure to ticagrelor. Consider the risks and benefits of treatment when using in moderate hepatic impairment, as no studies has been conducted
- Ticagrelor therapy can cause mild to moderate dyspnea, which often resolves during continued treatment. Do not discontinue ticagrelor therapy
- Avoid interruption of ticagrelor therapy as it will increase the risk of myocardial infarction, stent thrombosis, and death. If discontinued temporarily, restart as soon as possible
- Avoid use with strong CYP3A inhibitors and also potent CYP3A inducers, as it is metabolized by CYP3A4/5
Cautions: Use cautiously in
- Moderate hepatic impairment
- Concomitant use of drugs increasing bleeding risk
- Elderly
Supplemental Patient Information
- Advise patient not to discontinue ticagrelor without discussing with the prescribing physician
- Advise patient not to exceed 100 mg/day dose of aspirin
- Patient should be advised to immediately report any unanticipated, prolonged or excessive bleeding
Pregnancy Category:C
Breastfeeding: It is unknown whether ticagrelor or its active metabolites are excreted in human milk. As many drugs are excreted in human milk, and because of the potential for serious adverse reactions in nursing infants a decision should be made whether to discontinue nursing or to discontinue drug, taking into account the importance of the drug to the mother.
