Home Drug Guide Ticagrelor

Drug Guide

Generic Name

Ticagrelor

Brand Names Brilinta

Classification

Therapeutic: Antiplatelet agent

Pharmacological: P2Y12 receptor antagonist

FDA Approved Indications

Prevention of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS), including unstable angina, NSTEMI, and STEMI

Mechanism of Action

Ticagrelor reversibly binds to the P2Y12 receptor on platelets, inhibiting platelet activation and aggregation, thereby reducing the risk of thrombus formation.

Dosage and Administration

Adult: 180 mg loading dose followed by 90 mg twice daily

Pediatric: Not approved for pediatric use

Geriatric: Use with caution; monitor for bleeding risk

Renal Impairment: Adjust dose as needed; careful in severe impairment

Hepatic Impairment: Use with caution; clinical data limited

Pharmacokinetics

Absorption: Rapid absorption with peak plasma levels at approximately 1.5 hours

Distribution: Highly protein-bound (~99%)

Metabolism: Metabolized primarily by CYP3A4/5 enzymes

Excretion: Excreted mainly via feces (~58%) and urine (~27%)

Half Life: About 7 hours for the active metabolite

Contraindications

Active pathological bleeding
History of intracranial hemorrhage

Precautions

History of bleeding disorders, severe hepatic impairment, concomitant use of other anticoagulants or antiplatelet agents, risk of bleeding

Adverse Reactions - Common

Bleeding (Very common)
Dyspnea (Common)
Bradyarrhythmias (Uncommon)

Adverse Reactions - Serious

Heavy bleeding, including intracranial hemorrhage (Rare)
Angioedema (Rare)
Chronic thrombotic microangiopathy (Rare)

Drug-Drug Interactions

CYP3A inhibitors (e.g., ketoconazole, clarithromycin) may increase ticagrelor levels.
CYP3A inducers (e.g., rifampin) may decrease effectiveness.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of bleeding, assess platelet counts, liver function tests as indicated

Diagnoses:

Risk for bleeding

Implementation: Administer as prescribed, educate patient about bleeding precautions, monitor for adverse effects

Evaluation: Effectiveness in preventing thrombotic events, presence of bleeding complications

Patient/Family Teaching

Inform about signs of bleeding (e.g., bleeding gums, blood in stool or urine), avoid activities that increase bleeding risk, take medication exactly as prescribed
Report any unusual bleeding or signs of allergic reactions promptly

Special Considerations

Black Box Warnings:

SIGNIFICANT bleeding risk

Genetic Factors: Limited data, no current specific genetic considerations

Lab Test Interference: May increase bleeding time; monitor as clinically indicated

Overdose Management

Signs/Symptoms: Excessive bleeding, hemorrhagic events

Treatment: Discontinue drug, provide supportive care, consider blood products or surgical interventions as needed

Storage and Handling

Storage: Store at room temperature, away from moisture and light

Stability: Stable up to the expiration date on the package