Apo-Ticagrelor

When ticagrelor is used to prevent clotting for people with acute coronary syndrome (ACS),** the usual starting dose of ticagrelor is 180 mg (two 90 mg tablets) for one dose, then 90 mg twice a day.**

When ticagrelor is used to prevent clotting for people with a history of heart attack that occurred more than 1 year in the past,** the recommended dose is 60 mg taken by mouth 2 times a day.**

When ticagrelor is used to prevent clotting for people who have no history of heart attack, but who have coronary artery disease and type 2 diabetes and have had a procedure to open a narrowed or blocked blood vessel, the recommended dose is 60 mg taken by mouth 2 times a day.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Ticagrelor may be taken with or without food and should be swallowed whole with water. For people that are unable to swallow tablets whole, the 90 mg tablet can be crushed to a fine powder and mixed in ½ glass of water. Consume the contents of the glass immediately. Rinse the glass with another ½ glass of water and immediately drink this.

If you are taking this medication, you will probably also be taking 75 mg to 150 mg of acetylsalicylic acid (ASA) daily.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

60 mg
Each pink, round-shaped, biconvex film-coated tablet, engraved with “APO” on one side and “T” over “60” on the other side, contains 60 mg of ticagrelor. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, isomalt 75:25, magnesium stearate, polyethylene glycol, polyvinyl alcohol, powdered cellulose, red ferric oxide, talc, and titanium dioxide.

90 mg
Each yellow, round-shaped, biconvex film-coated tablet, engraved with “APO” on one side and “T” over “90” on the other side, contains 90 mg of ticagrelor. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, isomalt 75:25, magnesium stearate, polyethylene glycol, polyvinyl alcohol, powdered cellulose, talc, titanium dioxide, and yellow iron oxide.

Do not take this medication if you:

• are allergic to ticagrelor or any ingredients of this medication

• are taking medications known as strong CYP3A4 inhibitors, such as ketoconazole, clarithromycin, ritonavir, and atazanavir

• have a history of bleeding in the brain

• have moderately to severely reduced liver function

• have problems with bleeding (e.g., stomach or intestinal ulcer, bleeding in the brain)

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain

• bleeding gums

• constipation

• cough

• diarrhea

• dizziness

• fatigue

• headache

• heartburn

• itching

• muscle weakness

• nausea

• runny nose

• sore throat

• spinning sensations

• tingling feeling

• trouble sleeping

• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• anxiety

• irregular breathing

• chest pain

• confusion

• fainting

• fast, slow, or irregular heartbeat

• shortness of breath

• signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)

• signs of bleeding (e.g., black and tarry stools, blood in urine, nosebleeds, blood in your eye) or unusual bruising

• signs of gout (e.g., joint pain, swelling and warmth of joints)

• signs of thrombotic thrombocytopenic purpura (TTP; e.g. fever, purplish spots on the skin or mouth, yellowing of the skin or eyes, extreme tiredness, confusion)

• skin rash

• stomach inflammation

• swelling of legs or ankles

• symptoms of heart failure (e.g., shortness of breath; cough; needing extra pillows to breathe at night; swelling of the feet, ankles, or lower legs)

• symptoms of high blood pressure in the lungs (e.g., shortness of breath, dizziness, fatigue, racing pulse)

• symptoms of kidney stones (e.g., painful urination, pain in side and back, below the ribs)

• symptoms of low blood pressure (e.g., dizziness, lightheadedness, blurred vision)

• symptoms of lung fibrosis (e.g., shortness of breath, dry cough, unexplained weight loss, fatigue, aching joints and muscles)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of bleeding in the stomach (e.g., bloody, black, or tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)

• symptoms of bleeding in the brain (e.g., sudden severe headache, confusion, nausea, vomiting, seizures, loss of consciousness)

• symptoms of a severe allergic reaction (e.g., hives; difficulty breathing; or swelling of the face, mouth, tongue, or throat)

• symptoms of a stroke (e.g., sudden dizziness, numbness, weakness, vision changes, headache, difficulty speaking, difficulty walking)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

**ASA dose: **This medication is usually used along with low doses of acetylsalicylic acid (ASA) unless there is a reason you should not take ASA. The dose of ASA should not be greater than 150 mg daily.

**Bleeding: **Ticagrelor can increase your risk of bleeding. If you are at risk of bleeding (e.g., have had recent trauma, surgery, dental procedures, bleeding in the stomach or intestines, reduced liver function) or are taking any medications that increase your risk of bleeding (e.g., blood thinners, nonsteroidal anti-inflammatory medication), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Tell your doctor of any signs that your blood is not clotting as quickly as usual. Such symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding.

Breathing problems: Ticagrelor can cause shortness of breath for some people. It is usually mild to moderate and typically gets better as your body adjusts to the medication. If you have asthma or chronic obstructive pulmonary disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dizziness/reduced alertness: Ticagrelor may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.

**Grapefruit juice: **Grapefruit juice affects how ticagrelor is removed from the body and may cause too much of the medication to build up in the body, possibly causing harmful side effects. Do not drink grapefruit juice or eat grapefruit at any time while taking this medication.

Irregular breathing: This medication may increase the risk of developing conditions related to irregular breathing, such as sleep apnea and Cheyne-Stokes breathing. If you notice any changes in your breathing patterns (e.g., speeding up, slowing down, or short pauses in breathing), contact your doctor as soon as possible.

**Heart rhythm: **This medication may cause changes in heart rhythm. If you have certain abnormal heart rhythms (e.g., sick sinus syndrome, 2nd- or 3rd-degree heart block, or fainting because of a slow heartbeat, and do not have a pacemaker) or are taking medication that slows the heart rate (e.g., atenolol, diltiazem, verapamil, metoprolol), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

**High uric acid levels and gout: **Ticagrelor may cause an increase in the amount of uric acid in the blood. If you have or have had high uric acid blood levels or gout, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you develop painful, warm, and swollen joints or difficulty with urination, contact your doctor as soon as possible.

**Kidney function: **If you are receiving dialysis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

**Liver function: **Ticagrelor is broken down by the liver so it can be removed from the body. Liver disease or reduced liver function may cause a build-up of ticagrelor in the body and cause side effects. If you have liver disease or decreased liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you have moderately to severely reduced liver function, you should not take this medication.

**Stopping medication: **If you stop this medication, you will be at an increased risk of having a stroke or heart attack. If your doctor suggests stopping this medication temporarily because of side effects, it should be restarted as soon as the risk of the side effect is less than the risk of not taking the medication.

**Surgery: **If you have elective (planned) surgery, your doctor will tell you when to stop taking this medication before the surgery.

**Pregnancy: **The safety of using this medication during pregnancy has not been established. If you could become pregnant while taking this medication, use appropriate birth control to prevent pregnancy.

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

**Breast-feeding: **It is not known if ticagrelor passes into breast milk. If you are breast-feeding and taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

**Children: **The safety and effectiveness of using this medication have not been established for children and adolescents less than 18 years of age.

There may be an interaction between ticagrelor and any of the following:

• abrocitinib

• acetylsalicylic acid (ASA) at doses more than 150 mg daily

• anagrelide

• apalutamide

• apixaban

• aprepitant

• "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)

• bismuth subsalicylate

• bosentan

• carbamazepine

• clopidogrel

• cobicistat

• cyclosporine

• dabigatran

• digoxin

• diltiazem

• dronedarone

• edoxaban

• eslicarbazepine

• enzalutamide

• fondaparinux

• fosphenytoin

• grapefruit juice

• heparin

• herbal products that affect bleeding (e.g., garlic, ginger, gingko biloba, ginseng, St John's wort, saw palmetto)

• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)

• HIV protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir)

• icosapent ethyl

• lenacapavir

• letermovir

• lomitapide

• low molecular weight heparins (LMWHs; e.g., dalteparin, enoxaparin, tinzaparin)

• lumacaftor and ivacaftor

• macrolide antibiotics (e.g., clarithromycin, erythromycin)

• mifepristone

• modafinil

• multivitamins

• narcotic pain relievers (e.g., fentanyl, morphine)

• nirmatrelvir and ritonavir

• nonsteroidal anti-inflammatory medication- NSAIDs (e.g., celecoxib, ibuprofen, ketoprofen, naproxen)

• obinutuzumab

• omega-3-fatty acids

• pentoxifylline

• phenobarbital

• phenytoin

• prasugrel

• primidone

• protein kinase inhibitors (e.g., crizotinib, dasatinib, imatinib, nilotinib)

• rifabutin

• rifampin

• rivaroxaban

• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vortioxetine)

• serotonin-norepinephrine reuptake inhibitors (SNRIs; desvenlafaxine, duloxetine, venlafaxine)

• "statin" anti-cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin)

• verapamil

• vilazodone

• vitamin E

• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,

• change one of the medications to another,

• change how you are taking one or both of the medications, or

• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Apo-Ticagrelor