Lacrat (Ticagrelor)

• Ticagrelor is used to manage platelet‑mediated cardiovascular conditions, particularly in the setting of atherosclerotic disease and acute coronary events.
• Acute coronary syndrome: reduces the risk of cardiovascular death, myocardial infarction and stroke.
• Atherosclerotic disease: prevents recurrent stroke in patients with prior cerebrovascular events.
• Myocardial infarction secondary prevention: lowers the incidence of new myocardial infarction in patients with established coronary artery disease.

• Ticagrelor reversibly binds to the platelet P2Y12 ADP receptor, blocking ADP‑mediated activation of the G‑protein signaling cascade. This inhibition prevents the conformational change of the glycoprotein IIb/IIIa receptor, thereby reducing fibrinogen binding and platelet aggregation, which diminishes thrombus formation in arterial vessels.

Ticagrelor may cause a range of adverse reactions, from mild to serious.

Common Side Effects

• Dyspnea: shortness of breath, often transient.
• Headache: mild to moderate intensity.
• Nausea: occasional gastrointestinal upset.
• Minor bleeding: bruising or gum bleeding.
• Dizziness: occasional light‑headedness.
• Diarrhea: loose stools in some patients.

Serious or Rare Side Effects

• Severe bleeding: gastrointestinal or intracranial hemorrhage.
• Allergic reactions: rash, pruritus, or anaphylaxis.
• Hepatic injury: elevated liver enzymes or hepatitis.
• Thrombocytopenia: markedly reduced platelet count.
• Hyperuricemia: increased serum uric acid levels.
• Bradyarrhythmia: unusually slow heart rate.

• Before prescribing Ticagrelor, clinicians should evaluate patient‑specific risk factors and monitor for potential complications.
• Assess bleeding risk: review history of hemorrhage, recent surgery or trauma.
• Evaluate hepatic function: adjust use in patients with severe liver disease.
• Monitor renal function: consider dose adjustment in severe renal impairment.
• Avoid in patients with active pathological bleeding: contraindicated when bleeding is uncontrolled.
• Store at ambient temperature: keep below 25°C, retain in original packaging, protect from moisture and direct sunlight.

Ticagrelor interacts with several drug classes; awareness of these interactions helps prevent adverse outcomes.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase ticagrelor exposure and bleeding risk.
• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce efficacy, increasing thrombotic risk.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): combined use heightens bleeding potential.

Moderate Interactions (Monitor Closely)

• Aspirin: additive antiplatelet effect may raise bleeding incidence.
• NSAIDs (e.g., ibuprofen, naproxen): monitor for gastrointestinal bleeding.
• Statins metabolized by CYP3A4 (e.g., simvastatin): may increase statin levels; consider dose adjustment.