Ticagrelor

Reduce CV death, MI and stroke after ACS or in patients with a history of MI; also reduce ACS-associated stent thrombosis. Reduce first MI or stroke in high-risk CAD without prior MI/stroke; efficacy in that setting was established in patients with type 2 diabetes, although the indication is not limited to that population.

Reduce stroke risk after acute ischemic stroke with NIHSS ≤5 or high-risk TIA. THALES excluded NIHSS >5 and thrombolysis recipients; use in those populations is not recommended by the label. This is not a regimen for hemorrhagic stroke or indefinite treatment of every TIA.

With or without food. If swallowing is difficult, crush tablets, mix in water and drink; may administer into the stomach through an NG tube CH8 or larger. Skip the missed dose and take the next at its scheduled time. Do not coadminister another oral P2Y12 inhibitor. If clinically necessary and possible, interrupt 5 days before surgery with major bleeding risk; restart as soon as hemostasis permits. This is a prescriber-directed plan, not permission to stop for routine procedures.

History of intracranial hemorrhage; active pathological bleeding, such as intracranial bleeding or bleeding peptic ulcer; hypersensitivity to ticagrelor or any component, including angioedema. Severe hepatic impairment is labeled avoidance, distinct from the formal section 4 contraindications.

Serious, sometimes fatal bleeding; active pathological bleeding or previous intracranial hemorrhage prohibit use. Do not initiate in patients undergoing urgent CABG. Manage bleeding without discontinuation when possible because stopping increases subsequent CV events.

Bleeding and dyspnea are the main common reactions; ventricular pauses, rash, central sleep apnea and rare thrombotic thrombocytopenic purpura are reported. TTP requires prompt treatment. Excess dosing may cause bleeding, GI symptoms and ventricular pauses: obtain urgent professional assessment and ECG monitoring as indicated. Ticagrelor is not dialyzable; label states platelet transfusion did not reverse platelet inhibition in healthy volunteers and may not provide clinical benefit. No home reversal plan or contemporary antidote-availability claim inferred.

Avoid strong CYP3A inhibitors, such as clarithromycin, azole antifungals or ritonavir, which increase exposure; avoid strong inducers, such as rifampin, carbamazepine, phenytoin or phenobarbital, which reduce efficacy. Do not use another oral P2Y12 inhibitor simultaneously. Adhere to indication-specific aspirin dosing and clinician-directed post-PCI monotherapy decisions.

Avoid simvastatin or lovastatin doses >40 mg/day with ticagrelor. Rosuvastatin exposure can increase through BCRP inhibition; monitor statin-related adverse effects. Monitor digoxin levels when starting or changing ticagrelor because of P-glycoprotein inhibition.

Opioids can delay/reduce ticagrelor absorption. In ACS requiring morphine or another opioid agonist, clinicians should consider a parenteral antiplatelet agent; this is not an independent outpatient substitute or switch algorithm.

No renal dose adjustment is required by labeling. ESRD dialysis patients were not enrolled in clinical efficacy/safety trials; pharmacokinetics/platelet inhibition do not prove similar outcomes, and dialysis does not remove the drug. No adjustment for mild hepatic impairment; moderate impairment has limited experience and needs risk/benefit review; avoid severe impairment.

Pediatric safety/effectiveness are unestablished; the sickle-cell trial did not demonstrate reduction in vaso-occlusive crises. Trials found no overall older-adult safety/effectiveness difference, but bleeding risk and comorbidity still require individual assessment. No pediatric dose inferred.

Available pregnancy case reports have not identified a drug-associated major-birth-defect or miscarriage signal; animal studies identified developmental toxicity at higher exposures. Human data remain limited and clinical benefit/risk needs assessment. Human milk data are absent; breastfeeding is not recommended during treatment. No pregnancy safety guarantee or universal post-treatment milk-discard interval.

Ticagrelor and its active metabolite reversibly inhibit platelet P2Y12 ADP-receptor signaling, reducing activation and aggregation. CYP2C19 loss-of-function status did not determine thrombotic outcomes in the PLATO genetic substudy; no genotype-based ticagrelor dose adjustment inferred.

Median parent peak about 1.5 hours; bioavailability about 36%. CYP3A4 produces an active metabolite; both are >99% protein bound. Elimination is mainly hepatic metabolism and fecal/biliary handling, with <1% unchanged parent/metabolite urinary recovery. Half-lives are about 7 hours parent and 9 hours active metabolite; these do not justify extra missed doses or dialysis removal.

Assess bleeding history, active bleeding, organ disease, indication/time since event and prescribed aspirin plan. Review bruising, blood in stool/urine, prolonged bleeding, dyspnea, pulse/syncope and sleep-apnea symptoms. Obtain relevant clinical blood counts/organ testing as indicated; no universal laboratory timetable or routine INR target is established. Monitor digoxin or statin toxicity for relevant combinations and inform HIT-test laboratories.

Take twice daily as prescribed; do not double after a missed dose or stop without the treating team. Report prolonged or unexpected bleeding and new/severe breathlessness promptly; severe bleeding, fainting or neurologic symptoms need emergency assessment. Avoid extra aspirin-containing products and report all medicines. Tell surgeons/dentists before procedures; breastfeeding is not recommended. Provide the Medication Guide.

Appearance

Round, biconvex yellow film-coated tablet; 90 above T on one side.

Package

60-tablet bottle NDC 0186-0777-60; hospital unit-dose 100 NDC 0186-0777-39.

Status

Prescription oral NDA product; clinical PI revised May 2026.

60 mg

Round, biconvex pink film-coated tablet; 60 above T. Bottle of 60, NDC 0186-0776-60.

90 mg

Oral tablet strength distinct from the 60 mg long-term regimen; no injectable ticagrelor inferred.

Product scope

Other manufacturers’ appearance/excipients require their labels. Crushed oral/NG preparation is supported for this product; no independent switching or blanket DAPT duration.

Store at 25°C, with permitted excursions 15–30°C. Provide the Medication Guide and follow the actual package expiration. No universal stored crushed-mixture stability period is supplied; prepare according to exact product instructions.