Igzelym (Ticagrelor)

Ticagrelor is used to manage platelet‑mediated thrombotic conditions within the acute coronary syndrome spectrum.

• Acute coronary syndrome (ACS): reduces the risk of cardiovascular death, myocardial infarction and stroke in patients with ACS.
• ST‑elevation myocardial infarction (STEMI): provides antiplatelet protection during and after reperfusion therapy.
• Non‑ST‑elevation myocardial infarction (NSTEMI): helps prevent recurrent ischemic events in NSTEMI patients.
• Post‑percutaneous coronary intervention (PCI): serves as part of dual antiplatelet therapy to maintain vessel patency.

• Ticagrelor reversibly binds to the platelet P2Y12 ADP receptor, blocking ADP‑mediated activation and aggregation of platelets. By inhibiting this key pathway, it reduces thrombus formation without requiring metabolic activation, offering rapid and consistent antiplatelet effects across a broad patient population.

Ticagrelor may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Dyspnea: shortness of breath occurring in many patients.
• Bleeding: including gum bleeding, bruising, or gastrointestinal hemorrhage.
• Headache: mild to moderate intensity.
• Nausea: occasional upset stomach.
• Dizziness: sensation of light‑headedness.
• Hypotension: transient low blood pressure.

Serious or Rare Side Effects

• Severe bleeding: life‑threatening hemorrhage such as intracranial bleed.
• Myocardial infarction recurrence: new heart attack while on therapy.
• Thrombocytopenia: marked reduction in platelet count.
• Hepatic injury: elevated liver enzymes or hepatitis.
• Allergic reactions: rash, angioedema or anaphylaxis.
• Atrioventricular block: conduction disturbances.

When prescribing Ticagrelor, clinicians should observe several precautionary measures to ensure patient safety.

• Assess bleeding risk: evaluate history of hemorrhage before initiating therapy.
• Avoid in active pathological bleeding: discontinue if uncontrolled bleeding occurs.
• Monitor hepatic function: use with caution in patients with liver impairment.
• Use cautiously in elderly: increased sensitivity to bleeding complications.
• Review concomitant CYP3A4 inhibitors: strong inhibitors may raise drug levels.
• Store at ambient temperature: keep below 25°C in the original container, protect from moisture.

Ticagrelor interacts with several medicines that can alter its antiplatelet effect or increase adverse events.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase plasma concentrations and bleeding risk.
• Combined use with other antiplatelet agents (e.g., clopidogrel, aspirin): heightens bleeding potential.
• Concurrent anticoagulants (e.g., warfarin, direct oral anticoagulants): synergistic anticoagulation leading to severe hemorrhage.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): additive gastrointestinal bleeding risk.
• Rifampicin: may reduce efficacy by inducing metabolism.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inducers (e.g., carbamazepine, phenytoin): may lower drug exposure.
• Statins metabolized by CYP3A4 (e.g., simvastatin, atorvastatin): monitor for increased statin levels.
• Digoxin: potential for altered plasma levels.
• Calcium channel blockers (e.g., verapamil): may increase Ticagrelor concentrations.
• Proton pump inhibitors: assess for any impact on absorption.