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

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.