Ticarel 90

Indications

Ticarel, when used alongside acetylsalicylic acid (ASA), is prescribed for preventing atherothrombotic events in adults with acute coronary syndrome (ACS) or a history of myocardial infarction (MI), who are at a high risk of further cardiovascular events.

Pharmacology

Ticagrelor is a P2Y12 receptor antagonist that inhibits platelet aggregation by blocking the P2Y12 receptor. This action reduces the formation of thrombi, decreasing the risk of myocardial infarction and ischemic stroke in at-risk patients. Its combined effects, including modulation of PI3K, Akt, and potassium channels, help to prevent occlusive thromboses and manage platelet function.

Dosage & Administration

• Acute Coronary Syndrome (ACS): Start with a 180 mg loading dose (two 90 mg tablets) followed by 90 mg twice daily for 12 months, unless clinical circumstances require discontinuation.
• Post-Myocardial Infarction (MI): For long-term prevention, administer 60 mg twice daily to patients at high risk of further atherothrombotic events.
• Missed Dose: If a dose is missed, take the next dose at the scheduled time, but avoid doubling up.
• Elderly & Renal Impairment: No dosage adjustment needed for elderly patients or those with renal impairment. Use caution in severe hepatic impairment.

Interactions

• CYP3A4 Inhibitors: Avoid co-administration with strong CYP3A4 inhibitors (e.g., clarithromycin, ritonavir).
• CYP3A4 Inducers: Co-administration with CYP3A4 inducers like rifampicin is not recommended, as it may reduce Ticarel’s efficacy.
• CYP3A4 Substrates & P-gp Inhibitors: Use caution with drugs like digoxin, cyclosporine, or statins when taken with Ticarel.
• Other: Avoid co-administration with high doses of ASA (>300 mg) and be cautious when used alongside anticoagulants or other drugs altering hemostasis.

Contraindications

• Hypersensitivity to Ticagrelor or any of its components
• Active bleeding disorders, including intracranial hemorrhage
• Severe liver disease
• History of ischemic stroke
• Pregnancy and lactation

Side Effects

• Very Common: Dyspnoea, hyperuricaemia, bleeding disorders.
• Common: Headache, dizziness, gastrointestinal disturbances (e.g., nausea, diarrhoea), rash, and pruritus.
• Rare: Serious bleeding events, including intracranial hemorrhage, hypotension, and confusion.

Pregnancy & Lactation

Ticarel is contraindicated in pregnancy. It may pass into breast milk, so nursing mothers should discontinue breastfeeding or use alternative therapies if treatment with Ticarel is necessary.

Precautions & Warnings

• Bleeding Risk: Careful consideration in patients with active bleeding, recent trauma, or surgical procedures.
• Dyspnoea: Use caution in patients with a history of asthma or chronic obstructive pulmonary disease (COPD).
• Premature Discontinuation: Stopping Ticarel therapy early may increase the risk of cardiovascular events.
• Uric Acid & Renal Function: Monitor for hyperuricaemia and renal function during treatment, especially in older adults.

Overdose Effects

Overdose may cause gastrointestinal discomfort, dyspnoea, and ventricular pauses. In case of overdose, supportive treatment is recommended.

Therapeutic Class

Anti-platelet drugs

Storage Conditions

Store Ticarel in a cool, dry place, away from direct light and out of reach of children.