ticagrelor: clinical use

Prescribing considerations

• Confirm the licensed indication and individual balance between thrombotic and bleeding risk.
• Assess persistent or worsening dyspnoea for cardiac, respiratory and treatment-related causes.
• Use caution with bleeding predisposition, moderate hepatic impairment, asthma or COPD, hyperuricaemia or gout, and bradyarrhythmia risk.
• Safety and efficacy are not established in people under 18 years.

Contraindications and cautions

• Hypersensitivity to ticagrelor or an excipient
• Active pathological bleeding
• Previous intracranial haemorrhage
• Severe hepatic impairment
• Concurrent strong CYP3A4 inhibition

Monitoring

• Clinical evidence of bleeding, unexplained anaemia or reduced haemoglobin
• Renal function according to clinical circumstances
• Uric acid and gout symptoms when clinically indicated
• New or worsening dyspnoea
• Pulse, syncope or conduction symptoms in patients at bradycardic risk
• Infant bruising, bleeding, gastrointestinal symptoms or irritability if breastfeeding continues after specialist assessment

Clinical pharmacology

Ticagrelor is a direct-acting, selective and reversibly binding P2Y12 antagonist. It has an active metabolite, is mainly metabolised through CYP3A4, and is a P-glycoprotein substrate and weak inhibitor. Its platelet inhibition does not require metabolic activation and is reversible.

Formulation and product differences

• The selected film-coated tablet can be swallowed whole or crushed and mixed with water.
• The selected orodispersible tablet disperses on the tongue and can be swallowed with or without water.
• Both selected formulations support administration through a suitable nasogastric tube followed by a water flush.
• An orodispersible formulation is not available for every licensed tablet strength.

Dispersible tablet

Route: Oral

Strengths: 90 mg

Tablet

Route: Oral

Strengths: 60 mg, 90 mg