Lacrat (Ticagrelor)

• Ticagrelor is an antiplatelet agent used in cardiovascular disease to inhibit platelet aggregation.
• Acute coronary syndrome: reduces the risk of cardiovascular death, myocardial infarction, and stroke.
• Post‑percutaneous coronary intervention in ACS: prevents thrombotic complications after stent placement.
• Secondary prevention after myocardial infarction: lowers the chance of recurrent ischemic events.

• Ticagrelor binds reversibly to the platelet P2Y12 ADP receptor, blocking ADP‑mediated activation and aggregation of platelets. By preventing this key step in the clotting cascade, it reduces thrombus formation without requiring metabolic activation, offering rapid and consistent antiplatelet effects across patients.

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

Common Side Effects

• Dyspnea: shortness of breath, often transient.
• Bleeding: including gum, nose, or gastrointestinal bleeding.
• Bruising: easy bruising at minor trauma sites.
• Headache: mild to moderate intensity.
• Nausea: occasional upset stomach.
• Dizziness: light‑headed sensation.

Serious or Rare Side Effects

• Severe or life‑threatening bleeding, including intracranial hemorrhage.
• Myocardial infarction paradoxically occurring despite therapy.
• Hepatic injury: elevated liver enzymes.
• Allergic reactions: rash, pruritus, or anaphylaxis.
• Thrombocytopenia: low platelet count.
• Hyperuricemia: increased uric acid levels.

• Before initiating therapy, clinicians should evaluate individual risk factors and monitor patients closely.
• Assess bleeding risk: review history of hemorrhage or coagulopathy.
• Monitor renal function: adjust use in severe renal impairment.
• Avoid in active pathological bleeding: discontinue if bleeding occurs.
• Caution with concomitant anticoagulants: increased bleeding potential.
• Discontinue before surgery: follow recommended washout period.
• Store at ambient temperature: keep below 25°C, protect from moisture.

Ticagrelor interacts with several drug classes; careful management is required.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole): may raise ticagrelor plasma levels.
• Strong CYP3A4 inducers (e.g., rifampin): may reduce efficacy.
• Combined use with anticoagulants (e.g., warfarin, heparin): heightened bleeding risk.
• NSAIDs (e.g., ibuprofen): increase risk of gastrointestinal bleeding.

Moderate Interactions (Monitor Closely)

• CYP3A4 substrates (e.g., certain statins): may need dose adjustment.
• P‑gp inhibitors (e.g., verapamil): modest increase in exposure.
• Alcohol: can exacerbate bleeding tendencies.