View source for Ticagrelor

==General==
*Type: [[Antiplatelet]]
*Dosage Forms: Pill
*Common Trade Names: Brilenta

==Adult Dosing==
*ACS: 180mg (two 90mg tablets) loading dose 
**PO vs OG vs NG (depending on mental status)
*ACS patients who have received a loading dose of [[Clopidogrel]] may be started on Ticagrelor
*Maintenance: 90mg twice daily

==Pediatric Dosing==
*Undetermined

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: Category C
*Lactation: Undetermined
*Renal Dosing
**Adult
*** No adjustment necessary
**Pediatric
*Hepatic Dosing
**Adult
*** Mild impairment - no adjustment necessary
*** Moderate impairment - not defined but use caution as undergoes hepatic metabolism
*** Severe impairment - avoid use
**Pediatric

==Contraindications==
*Allergy to class/drug
*History of: 
**Intracranial hemorrhage
**Active pathological bleeding, such as peptic ulcer or intracranial hemorrhage
**Severe hepatic impairment

==Adverse Reactions==
===Serious===
*Major coronary artery bypass graft (CABG)–related bleeding (86%)<ref>http://www.drugs.com/cdi/ticagrelor.html -- Accessed April 2015</ref>
*Digoxin: Because of inhibition of the P-gp transporter, digoxin concentrations may be elevated, increasing the risk of toxicity. 
**Monitor digoxin concentrations with initiation of, or any change in, ticagrelor therapy

===Common===
*Cardiovascular
**Ventricular pause (6%)
**Atrial fibrillation
**Hypertension (4%)
**[[Chest pain]]
**[[Hypotension]](3%)
*CNS
**Headache (7%)
**Dizziness (5%)
**Fatigue (3%)
**Syncope/pre-syncope/loss of consciousness (2%)
*GI
**[[Diarrhea]], nausea (4%).
*Hematologic
**Non–CABG-related bleeding (9%)
*Pulmonary
**Dyspnea (14%)
**Cough (5%)

==Pharmacology==
*Half-life: 7 hours (ticagrelor) and 9 hours (active metabolite)
*Metabolism: liver (CYP3A4)
*Excretion: 26% excreted in urine (less than 1% as ticagrelor and the active metabolite); 58% excreted in feces
*Mechanism of Action: Reversibly binds to the P2Y 12 class of adenosine diphosphate (ADP) receptors on platelets to prevent signal transduction and platelet activation


==Indications by Condition==
''The following table is automatically generated from disease/condition pages across WikEM.''

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 |?Has Dose=Dose
 |?Has Context=Context
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==See Also==
*[[Antiplatelet medications]]
*[[Antiplatelet agent reversal]]

==References==
<references/>

[[Category:Pharmacology]]
Ticagrelor: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.