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Ticagrelor

Sounds like 'tie-ka-grel-or'

Key points about ticagrelor

Ticagrelor is an antiplatelet medicine.
It prevents your blood from forming clots which can lower your chance of having a heart attack or stroke.
Find out how to take it safely and possible side effects.

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Ticagrelor is an anti-platelet medication. It's used to prevent blood clots in adults who have chest pain (from angina) or who've had a heart attack (myocardial infarction).

It prevents your blood from forming clots by making it less sticky. Preventing clots in the blood vessels that lead to your brain and heart muscle helps lower your risk of having a stroke or heart attack.

In Aotearoa New Zealand ticagrelor is available as tablets (90 mg). It’s also called Ticagrelor Sandoz®.

Use with other anticoagulants or aspirin

Your healthcare provider may prescribe ticagrelor with low-dose aspirin to take alongside ticagrelor for up to 12 months. Aspirin is another antiplatelet medicine. Taking the 2 medicines together is called dual (two) anti-platelet therapy (DAPT).

Ticagrelor may also be used in combination with anticoagulant medicines such as dabigatran, rivaroxaban or warfarin.

These medicines taken together, can be very effective. But, there’s a higher risk of bleeding, usually in your stomach or gut.
This risk increases with age. See below for signs of severe bleeding.
This combination of treatment is usually prescribed for a maximum time of 12 months. After this, your specialist will usually tell you to stop 1 of the 2 antiplatelet medications. It’s important to check with your healthcare provider when you should stop taking them both together.

The usual dose of ticagrelor is 90 mg (1 tablet) twice a day. You may be given a starting dose of 2 tablets the first time you take it.
Always take your ticagrelor exactly as your healthcare provider has told you. The pharmacy label will tell you how much ticagrelor to take, how often to take it and any special instructions.

Timing: Take your ticagrelor doses at the same times each day, in the morning and the evening.
Food: You can take ticagrelor with or without food.
Swallow your tablets with a glass of water: If you have problems swallowing the tablet, you can crush it and mix it with half a glass of water just before taking it. To make sure there's no medicine left behind, rinse the empty glass with another half a glass of water and drink it.
Missed dose: If you forget to take your dose, take it as soon as you remember that day. But if it's nearly time for your next dose, just take the next dose at the usual time. Don't take double the dose.
Tell your healthcare provider: It's important to let anyone who gives you treatment know that you're taking ticagrelor. This includes your dentist, pharmacist, podiatrist and nurse. You may need to stop using this medicine for several days before having surgery, dental appointments or medical tests.

Here are some things to know when you're taking ticagrelor. Other things may be important as well, so ask your healthcare provider what you should know about.

Other medicines:
- Ticagrelor interacts with some medicines, especially anti-inflammatories such as diclofenac (eg, Voltaren®) and ibuprofen (eg, Nurofen®). These can also be found in some cold and flu medicines (eg, Nurofen Cold and Flu®). Taking these together with ticagrelor may increase your risk of bleeding and should be avoided.
- It may also interact with herbal supplements (eg, St John’s Wort, garlic, gingko or ginseng) and rongoā Māori. Check with your healthcare provider before starting ticagrelor and before starting any new products.

Alcohol: Ticagrelor can make you feel dizzy. If you drink alcohol this can make you feel more dizzy.
Grapefruit, grapefruit juice or sour/Seville oranges: Avoid grapefruit, grapefruit juice or foods containing grapefruit while taking ticagrelor. It can increase your chance of side effects. Read more about grapefruit and medicines(external link).
Surgical procedures including dental work: It's important to let healthcare providers know that you're taking ticagrelor. You may need to stop taking ticagrelor for several days before having surgery.
Keep taking ticagrelor regularly: You may just need to take it for a short time, but may take it long term. Your prescriber will advise you about how long to take it for. Talk to your doctor or nurse before stopping it.
Driving: Ticagrelor can make you dizzy. Be careful when driving or using tools until you know how this medicine affects you.
Pregnancy or breastfeeding: Talk to your healthcare provider if you're pregnant, planning a pregnancy or want to breastfeed.
Monitoring: Ticagrelor can make your increase the amount of uric acid in your blood. You may have blood tests to check this.

Like all medicines, ticagrelor can cause side effects, although not everyone gets them.

Increased risk of bleeding

Ticagrelor increases your risk of bleeding. You might bleed or bruise more easily while you’re taking ticagrelor.

If you cut yourself, it might take slightly longer than normal to stop the bleeding. Minor bleeding such as a nosebleed should usually stop on its own.

If you have a fall or hurt your head or body, get medical attention immediately, even if you feel okay.

Signs of severe bleeding

If you have any of the following signs of bleeding, contact your doctor immediately or ring Healthline for free 24-hour health advice 0800 611 116.

Becoming pale, very weak and tired, or short of breath.
Any bleeding from your gums or cuts or nosebleeds that won’t stop.
Blood in your stools (poo) – black, tarry stools.
Blood in your urine (wee, mimi) – pink, red or brown-coloured urine.
Coughing up blood or vomit that looks like coffee grounds.
Sudden numbness or weakness of your arm, leg or face, especially if it's only on 1 side of your body.
Sudden confusion, difficulty speaking or understanding others.
Sudden difficulty in walking or loss of balance or co-ordination.
Suddenly feeling dizzy or sudden severe headache with no known cause.

Side effects	What should I do?
Longer bleeding time Nosebleeds Bruising Bleeding under the skin (blood blisters)	These are common. Any bleeding may take longer than normal to stop. If these happen often and they bother you, talk to your doctor.
Indigestion Tummy pain Nausea (feeling sick) Diarrhoea (runny poos) Feeling short of breath	These are common and usually go away with time. Try taking ticagrelor with or after a meal and eat simple foods. Tell your doctor if these bother you or they continue after a few weeks.
Feeling dizzy	This is common. Be careful when driving or using tools until you know how this medicine affects you. Limit alcohol.
Signs of higher levels of uric acid such as pain and swelling in your joints	Ticagrelor can increase the level of uric acid in your blood and cause a flare up of gout. Tell your doctor.
Signs of an allergic reaction such as skin rash, itching, swelling of the lips, face, and mouth or difficulty breathing	This is rare. Tell your doctor immediately or ring Healthline 0800 611 116.