Tildex

Indications

Ticagrelor is used together with low-dose Aspirin to prevent heart attacks, strokes and death from heart disease in people who have had an acute coronary syndrome (a heart attack or unstable angina), including those treated with a stent. It is also used long term in some people who had a heart attack at least a year ago and remain at high risk.

How It Works

It is an antiplatelet medicine. It blocks a receptor (P2Y12) on platelets, the small blood cells that clump together to form clots. This makes clots less likely to form in the heart arteries and in stents.

Dosage and Administration

Adults, after an acute coronary syndrome: a starting dose of 180 mg (two 90 mg tablets) at once, then 90 mg twice a day, usually for 12 months, together with Aspirin 75 to 100 mg a day unless the doctor says otherwise. Longer-term use after a past heart attack: usually 60 mg twice a day, as prescribed. Take with or without food. Tablets can be crushed and mixed with water if swallowing is difficult. If you miss a dose, take the next one at the usual time; do not double up.

Interactions

• Do not take with strong enzyme blockers such as Ketoconazole, Clarithromycin or Ritonavir, which raise its levels a lot.
• Rifampicin, Carbamazepine, Phenytoin and Phenobarbital can make it less effective.
• Aspirin doses above 100 mg a day reduce its benefit.
• Simvastatin or Lovastatin above 40 mg a day are not advised with it.
• Warfarin, other blood thinners, pain killers such as Ibuprofen, and antidepressants such as Fluoxetine increase bleeding risk.
• Digoxin levels may rise and should be monitored. Morphine can delay its effect.

Contraindications

• Active bleeding, such as a bleeding stomach ulcer.
• Any past bleeding inside the brain.
• Severe liver disease.
• Use with strong enzyme blockers (listed above).
• Allergy to ticagrelor or any ingredient of the product.

Side Effects

Common: bleeding and bruising more easily, nosebleeds, shortness of breath (often mild and may settle), dizziness, headache, diarrhoea and raised uric acid, which can cause gout.

Get urgent medical help for:

• Black or bloody stools, vomiting blood, or blood in the urine.
• Bleeding that will not stop.
• Sudden severe headache, weakness on one side, confusion or trouble speaking (possible bleeding in the brain).
• Severe or worsening breathlessness, or chest pain.
• Fainting or a very slow heartbeat.

Pregnancy and Lactation

Not recommended in pregnancy; women who could become pregnant should use contraception. Not recommended while breastfeeding.

Precautions and Warnings

• Do not stop it without talking to your heart doctor, as stopping early raises the risk of a heart attack or stent clot.
• Tell any dentist or surgeon that you take it; the doctor may ask you to stop it about 5 days before planned surgery.
• Tell the doctor about asthma or COPD, a slow heart rhythm, gout, or a history of bleeding.

Overdose

The main risk is serious bleeding. Get emergency medical help.

Therapeutic Class

Antiplatelet medicine (P2Y12 receptor blocker).

Storage

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