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Ticagrelor
📖 About
- Always check the BNF link here for full prescribing guidance.
- Ticagrelor is a P2Y12 receptor antagonist used as part of dual antiplatelet therapy (DAPT) with aspirin in acute coronary syndromes (ACS).
⚙️ Mode of Action
- 🩸 Blocks the P2Y12 ADP receptor on platelets → prevents activation and aggregation.
- 🔄 Unlike clopidogrel/prasugrel, it is a non-thienopyridine and causes reversible inhibition of platelet function.
- ⚡ Onset of action is rapid, and no metabolic activation is required (active drug as given).
💊 Indications / Dose
- STEMI / NSTEMI undergoing PCI 🫀: Ticagrelor 180 mg PO loading dose, then 90 mg PO twice daily for 12 months, alongside aspirin.
- 📌 Duration of therapy may be shortened or extended depending on bleeding risk and cardiology advice.
📊 Dose Table (check BNF for updates)
| Name | Starting Dose | Frequency | Route |
|---|---|---|---|
| Ticagrelor | 180 mg | Stat (loading) | PO |
| Ticagrelor | 90 mg | BD | PO × 12 months (with aspirin) |
🔗 Interactions
- 📖 See BNF for complete list.
- ⚠️ Concomitant use with anticoagulants (warfarin, DOACs) ↑ bleeding risk.
- CYP3A4 inhibitors/inducers can alter ticagrelor levels.
⚠️ Cautions
- 🩸 Increased risk of bleeding (monitor clinically).
- 🔎 Check renal function: ticagrelor can cause ↑ creatinine (re-check at 1 month).
- 🧪 May also ↑ uric acid → caution in gout.
⛔ Contraindications
- 🚫 Active pathological bleeding (e.g. GI bleed, intracranial haemorrhage).
- 🚫 History of intracranial haemorrhage.
- 🚫 Severe hepatic impairment.
😬 Side Effects
- 🌬️ Dyspnoea (common, may occur at rest, usually benign but can cause discontinuation).
- 🩸 Bleeding (GI, surgical, intracranial).
- ⬆️ Creatinine (check at 1 month).
- ⬆️ Hyperuricaemia (may precipitate gout).
📚 References
- BNF – Ticagrelor
- ESC & ACC/AHA guidelines on ACS and dual antiplatelet therapy.
📝 Revisions
- Updated September 2025
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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