Adult Dosing

Reduction of risk of thrombotic stroke

• 250 mg PO bid with meals

• Reserve use for those who are intolerant or allergic to aspirin or who have failed aspirin therapy

Coronary artery stenting

• 250 mg PO bid with food x 30 days, following successful stent implantation

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• To reduce the risk of thrombotic stroke (fatal or nonfatal) in patients who have experienced stroke precursors, and in patients who have had a completed thrombotic stroke and unable to tolerate aspirin
• As adjunctive therapy with aspirin to reduce the incidence of subacute stent thrombosis in patients undergoing successful coronary stent implantation

• Hypersensitivity to any of the ingredients of the drug
• Hematopoietic disorders such as neutropenia and thrombocytopenia or a past history of either TTP or aplastic anemia
• Hemostatic disorder or active pathological bleeding (such as bleeding peptic ulcer or intracranial bleeding)
• Severe liver impairment

• Ticlopidine can cause life-threatening hematological adverse reactions including neutropenia/agranulocytosis, thrombotic thrombocytopenic purpura (TTP) and aplastic anemia
• Hematological reactions cannot be reliably predicted by any demographic or clinical identifiers
• In clinical trials the evidence of neutropenia has been reported in 2.4% of the total population. Monitor hematologically and clinically for the evidence of neutropenia during first 3 months and if toxicity develops discontinue the treatment
• The incidence of ticlopidine associated thrombotic thrombocytopenic purpura (TTP) may be as high as one case in every 2000 - 4000 patients exposed. Monitor hematologically and clinically for the evidence of TTP during first 3 months and if toxicity develops discontinue the treatment
• The incidence of aplastic anemia may be as high as one case in every 4000 to 8000 patients exposed.
• Monitor hematologically and clinically for the evidence of aplastic anemia during first 3 months and if toxicity develops discontinue the treatment

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Severe hepatic impairment: Contraindicated

• Neutropenia associated with reduction in white blood cell precursors can occur suddenly with ticlopidine therapy. Within 1-3 wks of withdrawal of ticlopidine, the neutrophil count usually rises to >1200/mm³ [US Black Box Warning]
• TTP characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurological findings, renal dysfunction, and fever has been reported with ticlopidine therapy. Provide prompt treatment if TTP develops and avoid platelet transfusions as it may accelerate thrombosis [US Black Box Warning]
• Aplastic anemia presenting with signs or symptoms suggestive of infection, in association with low white blood cell and platelet counts can occur, provide prompt treatment to stimulate the bone marrow and to minimize the mortality associated with aplastic anemia [US Black Box Warning]
• Monitor hematological parameters before initiating treatment, then every 2 wks through out the therapy, and as ticlopidine's long plasma half-life continue monitoring for 2 weeks after discontinuation of therapy
• Increased serum cholesterol and triglycerides within 1 month of therapy has been observed. Monitor the patient for hyperlipidemia
• The tolerance and safety of co-administration of ticlopidine with heparin, oral anticoagulants or fibrinolytic agents have not been established. If a patient is switched from an anticoagulant or fibrinolytic drug to ticlopidine, discontinue the former drug prior to ticlopidine administration
• Discontinue the drug 10 to 14 days prior to elective surgery to eliminate the antiplatelet effects of ticlopidine

Cautions: Use cautiously in

• Renal impairment
• Hepatic impairment
• Risk of bleeding (trauma, surgery, pathological condition)
• GI lesions
• Hyperlipidemia

Pregnancy Category:B

Breastfeeding: Safety unknown; excreted in the milk of rats; because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants manufacturer recommends discontinuation of breastfeeding, or postponing of treatment (taking into account the importance of the drug to the mother).

• GI: Diarrhea, nausea, vomiting, GI pain, dyspepsia, flatulence, anorexia, abnormal LFT
• HEMA: Neutropenia, thrombocytopenia, TTP, aplastic anemia, leukemia, agranulocytosis, eosinophilia, pancytopenia, thrombocytosis, bone-marrow depression
• CNS: Dizziness
• DERM: Rash, pruritus, ecchymosis
• HEPA: Liver function test abnormal
• EENT: Epistaxis, conjunctival hemorrhage
• GU: Hematuria

• Platelet aggregation inhibitor; interferes with platelet membrane function by inhibiting ADP-induced platelet fibrinogen binding and subsequent platelet-platelet interactions
• Extensively metabolized by liver; CYP450: 2D6, 3A4, 2C19 inhibitor
• Renally excreted 60% (minimally unchanged); feces 23%
• Half-life:
• Single dose: 7.9-12.6 hrs
• Repeat dosing: 4-5 days

US Trade Name(s)

• Only generic available

US Availability

ticlopidine (generic)

• TABS: 250 mg

Canadian Trade Name(s)

• Only generic available

Canadian Availability

ticlopidine (generic)

• TABS: 250 mg

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• Tilodene

Australian Availability

Tilodene

• TABS: 250 mg

[Outline]

Hematology/Oncology

Antiplatelet Agents

Platelet Aggregation Inhibitors

Cardiovascular

Antiplatelet Agents

Platelet Aggregation Inhibitors

Neurologic

Antiplatelet Agents

Platelet Aggregation Inhibitors

Pricing data from www.DrugStore.com in U.S.A.

• Ticlopidine HCl 250 MG TABS [Bottle] (TEVA PHARMACEUTICALS USA)
  100 mg = $197.09
  300 mg = $558.4

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

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