ticagrelor at a glance
Medicine class
Direct, reversible P2Y12 platelet inhibitor
Main role
Prevention of further atherothrombotic events after acute coronary syndromes or previous myocardial infarction
Food
May be taken with or without food
Important practical point
Do not stop without clinical advice because interruption can increase cardiovascular risk
What is ticagrelor used for?
Licensed uses in adults include prevention of atherothrombotic events following:
Acute coronary syndromes, including unstable angina and myocardial infarction, whether managed medically or with coronary intervention.
A previous myocardial infarction in people at high risk of another atherothrombotic event.
How does ticagrelor work?
Ticagrelor binds directly and reversibly to platelet P2Y12 receptors, blocking ADP-driven platelet activation and aggregation. It also inhibits the ENT-1 transporter and may increase local adenosine effects, which may contribute to breathlessness.
ticagrelor preparations and strengths
Dispersible tablet
Route: Oral
Strengths: 90 mg
Tablet
Route: Oral
Strengths: 60 mg, 90 mg
How to take ticagrelor
Follow the dispensing label. Ticagrelor may be taken with or without food.
Film-coated tablets may be swallowed whole or, for the selected product, crushed to a fine powder, mixed with water and taken immediately. Rinse the glass with water and drink the rinse.
Place an orodispersible tablet on the tongue and allow it to disperse before swallowing, with or without water.
Both selected formulations support nasogastric-tube administration followed by a water flush.
ticagrelor side effects
Common or expected effects
- Breathlessness, usually mild or moderate
- Bruising or bleeding more readily
- Nose, gum, gastrointestinal or urinary-tract bleeding
- Headache, dizziness or fainting
- Nausea, indigestion, diarrhoea or constipation
- Rash or itching
- Raised uric acid or gout
- Increased blood creatinine
Get urgent medical advice
- Severe, persistent or uncontrolled bleeding
- Bleeding within the brain or other internal bleeding
- Severe allergic reaction or angioedema
- Thrombotic thrombocytopenic purpura
- Clinically important slow heart rhythm or heart block
- New, prolonged or worsening breathlessness
ticagrelor in pregnancy
Ticagrelor is not recommended during pregnancy because human evidence is limited and animal studies found reproductive toxicity. Contact the prescriber promptly if pregnancy occurs; do not stop treatment independently.
ticagrelor while breastfeeding
Evidence during breastfeeding is very limited, and infant risk cannot be excluded. Specialist guidance says cautious use may be possible for a full-term, healthy infant after individual assessment, with monitoring for vomiting, diarrhoea, irritability, bruising or bleeding.
ticagrelor interactions
A prescriber or pharmacist should review all prescribed, over-the-counter and herbal products because interactions can alter exposure or bleeding risk.
Strong CYP3A4 inhibitors, including clarithromycin, ketoconazole, ritonavir and atazanavir
Can markedly increase ticagrelor exposure and are contraindicated.
Strong CYP3A inducers, including rifampicin, carbamazepine, phenytoin and phenobarbital
Can reduce ticagrelor exposure and effectiveness; concurrent use is discouraged.
Common questions about ticagrelor
Answers are fully visible for fast scanning and source review.
Can ticagrelor be taken with food?
Yes. It can be taken with or without food.
Can ticagrelor tablets be crushed?
The selected film-coated tablet can be crushed and mixed with water. The orodispersible tablet should be allowed to disperse on the tongue or in water.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.