Ticlopid

Indications

Ticlopidine is an antiplatelet medicine used to lower the risk of stroke in people who have had a minor stroke or warning signs of stroke (transient ischaemic attacks) and who cannot take Aspirin. It has also been used, together with Aspirin, for a short time after a coronary stent is placed. Because of its blood-related side effects, newer medicines such as Clopidogrel are now usually preferred.

How It Works

Platelets are small blood cells that clump together to form clots. Ticlopidine blocks a receptor on platelets (the P2Y12 ADP receptor) so they are less sticky. This reduces the chance of a clot forming in narrowed arteries of the brain or heart.

Dosage and Administration

Adults: the usual dose is 250 mg twice daily, taken with food to improve absorption and reduce stomach upset. After a stent, it is taken for the limited time your doctor prescribes. Do not stop taking it suddenly without speaking to your doctor.

Interactions

• Aspirin, other NSAIDs (such as Ibuprofen), Warfarin, Heparin and other blood thinners increase the risk of bleeding.
• Ticlopidine can raise the levels of Theophylline and Phenytoin.
• Antacids can reduce its absorption; Cimetidine can increase its levels.
• It can lower the effect of Cyclosporine.

Contraindications

Do not take ticlopidine if you are allergic to it, have a blood disorder such as low white cells or platelets, or a history of thrombotic thrombocytopenic purpura (TTP) or aplastic anaemia, active bleeding (such as a bleeding stomach ulcer or bleeding in the brain), or severe liver disease.

Side Effects

• Diarrhoea, nausea, stomach pain, indigestion
• Skin rash, itching
• Bruising or bleeding more easily
• Raised cholesterol or liver tests
• Serious blood disorders: very low white blood cells (neutropenia), TTP (clots in small blood vessels with low platelets) and aplastic anaemia, most often in the first 3 months

Get urgent medical help if you have fever, sore throat or mouth ulcers, unusual bleeding or bruising, yellowing of the skin or eyes, pale skin with weakness, confusion, dark urine, black stools, or any sign of a stroke.

Pregnancy and Lactation

Ticlopidine is not usually recommended in pregnancy unless clearly needed and prescribed by a doctor. It may pass into breast milk, so it is generally avoided while breastfeeding.

Precautions and Warnings

Blood counts must be checked before starting and every 2 weeks for the first 3 months of treatment. Tell every doctor and dentist that you take ticlopidine; it may need to be stopped 10 to 14 days before planned surgery. Use with care in people with liver or kidney disease or a high bleeding risk.

Overdose

Overdose can increase bleeding risk and stomach upset. Get medical help straight away; platelet transfusion may be needed if serious bleeding occurs.

Therapeutic Class

Antiplatelet agent, thienopyridine P2Y12 receptor blocker.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.