TICAGRELOR Drug Interactions
Also known as: Ticagrelor
Ticagrelor is an anti-platelet medication that helps prevent blood clots. It works by making your platelets (tiny blood cells involved in clotting) less sticky, reducing the risk of serious heart problems like heart attacks and strokes, especially in people with acute coronary syndrome or a history of heart disease.TICAGRELOR has 10 documented drug interactions in our database, including 0 contraindicated, 10 major, 0 moderate, and 0 minor interactions.
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Minor
Combining naproxen with ticagrelor significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided due to the serious potential for harm.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase (COX-1 and COX-2), reducing prostaglandin synthesis, which impairs gastric mucosal protection and platelet aggregation. Ticagrelor is a P2Y12 inhibitor that prevents platelet activation and aggregation through a different mechanism. The concurrent use of both agents leads to an additive antiplatelet effect and increased gastrointestinal mucosal damage, profoundly elevating bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other major bleeding. Patients may experience symptoms like black, tarry stools, vomiting blood, unusual bruising, or prolonged bleeding from minor cuts. The risk of major bleeding is significantly elevated compared to either drug alone. This combination should generally be avoided. If an NSAID is absolutely necessary for a patient on ticagrelor, consider alternative pain management strategies or a short course of a COX-2 selective NSAID with a proton pump inhibitor (PPI) for gastric protection, though bleeding risk remains high. Closely monitor for any signs or symptoms of bleeding, and educate the patient on these risks. Discuss with the prescribing physician to determine the best course of action.
Combining etodolac with ticagrelor significantly increases your risk of serious bleeding, including stomach bleeding and stroke. Your doctor will likely avoid this combination or monitor you very closely.
Mechanism
Etodolac, an NSAID, inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Ticagrelor is a direct-acting, reversible P2Y12 platelet inhibitor, preventing platelet activation and aggregation. The combination results in additive antiplatelet effects and increased gastrointestinal mucosal damage, profoundly elevating bleeding risk.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, which can be severe or life-threatening. This includes gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other systemic bleeding events. Studies show a substantially higher risk of major bleeding with dual antiplatelet therapy plus NSAIDs compared to antiplatelet therapy alone. This combination should generally be avoided due to the high bleeding risk. If concurrent use is unavoidable, patients require very close monitoring for signs of bleeding (e.g., black stools, easy bruising, unusual fatigue). Consider alternative pain management strategies that do not increase bleeding risk, such as acetaminophen. Proton pump inhibitor co-prescription may reduce GI bleeding risk but does not eliminate it.
Combining aspirin and ticagrelor significantly increases your risk of bleeding, especially in the stomach and intestines. Your doctor will carefully weigh the benefits against this increased risk.
Mechanism
Aspirin, even at low doses, inhibits platelet aggregation irreversibly by blocking cyclooxygenase-1 (COX-1), reducing thromboxane A2 production. Ticagrelor is a direct-acting, reversible P2Y12 platelet inhibitor. The concurrent use of two antiplatelet agents results in additive antiplatelet effects, severely impairing the body's ability to form clots.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, but also includes intracranial hemorrhage and other major bleeding events. This combination can increase the risk of major bleeding by 2-3 fold compared to ticagrelor alone, and the risk of gastrointestinal bleeding is particularly high. This combination is often prescribed for specific cardiovascular conditions (e.g., acute coronary syndrome) where the antiplatelet benefits outweigh the bleeding risk. Close monitoring for signs of bleeding (e.g., black/tarry stools, unusual bruising, prolonged bleeding from cuts) is essential. Proton pump inhibitors (PPIs) may be co-prescribed to reduce gastrointestinal bleeding risk. Do not stop either medication without consulting your doctor.
Combining ibuprofen with ticagrelor significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to the heightened bleeding potential.
Mechanism
Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Ticagrelor is an antiplatelet agent that directly inhibits the P2Y12 receptor, preventing ADP-mediated platelet activation and aggregation. The concurrent use of these agents leads to additive antiplatelet effects and increased gastrointestinal mucosal damage, profoundly elevating bleeding risk.
Clinical Management
Patients taking both ibuprofen and ticagrelor are at a substantially increased risk of serious bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other major bleeding. The risk of gastrointestinal bleeding can be several-fold higher compared to ticagrelor alone, potentially leading to anemia, hospitalization, or even death. This combination should generally be avoided. If pain management is necessary, consider alternative analgesics such as acetaminophen. If an NSAID is absolutely required, use the lowest effective dose for the shortest possible duration, and consider gastroprotective agents (e.g., proton pump inhibitors). Closely monitor for signs of bleeding (e.g., black/tarry stools, unusual bruising, blood in urine).
Combining indomethacin with ticagrelor significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Ticagrelor is an antiplatelet agent that directly inhibits the P2Y12 receptor on platelets, preventing their activation and aggregation. The concurrent use of these agents results in additive antiplatelet effects and increased gastrointestinal mucosal damage from the NSAID, synergistically elevating bleeding risk.
Clinical Management
This combination substantially increases the risk of serious bleeding, including gastrointestinal hemorrhage (e.g., ulcers, melena, hematemesis), intracranial hemorrhage, and other systemic bleeding events. Studies show that combining NSAIDs with antiplatelets can increase the risk of major bleeding by several-fold compared to either drug alone, with GI bleeding being the most common and severe complication. This combination should generally be avoided due to the high risk of serious bleeding. If an NSAID is absolutely necessary, consider alternative pain management strategies or a COX-2 selective NSAID (like celecoxib) for the shortest possible duration, along with a proton pump inhibitor (PPI) for gastroprotection. Closely monitor for any signs of bleeding (e.g., black stools, easy bruising, nosebleeds). Consult a physician to discuss safer alternatives.
Combining celecoxib with ticagrelor significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to serious potential harm.
Mechanism
Celecoxib, like other NSAIDs, inhibits prostaglandin synthesis, which can impair gastric mucosal protection and platelet aggregation. Ticagrelor is a potent antiplatelet agent that prevents platelet activation and aggregation. The combined antiplatelet effects and gastrointestinal mucosal damage lead to a synergistic increase in bleeding risk.
Clinical Management
Patients are at a significantly elevated risk of major bleeding events, including gastrointestinal hemorrhage (e.g., ulcers, melena, hematemesis), intracranial hemorrhage, and other severe bleeding complications. The risk of GI bleeding can be several-fold higher compared to either drug alone. This combination should generally be avoided. If an NSAID is absolutely necessary, consider alternatives to celecoxib with lower GI risk (e.g., acetaminophen) or a proton pump inhibitor (PPI) for gastroprotection. Closely monitor for any signs of bleeding (e.g., black stools, easy bruising, nosebleeds) and consider dose adjustments or discontinuation under medical supervision.
Combining piroxicam with ticagrelor significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided unless absolutely necessary and under strict medical supervision.
Mechanism
Piroxicam, a non-selective NSAID, inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Ticagrelor is an antiplatelet agent that directly inhibits the P2Y12 receptor, preventing ADP-mediated platelet activation and aggregation. The concurrent use of these agents leads to an additive antiplatelet effect, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other serious bleeding events. The risk of major gastrointestinal bleeding can be several-fold higher compared to either drug alone, potentially leading to anemia, hospitalization, and in severe cases, life-threatening complications. This combination should be avoided if possible. If concomitant use is unavoidable, it should be for the shortest duration and at the lowest effective dose, with close monitoring for signs of bleeding (e.g., black stools, easy bruising, nosebleeds). Consider alternative pain management strategies that do not increase bleeding risk, such as acetaminophen. Proton pump inhibitors (PPIs) may be co-prescribed to reduce GI bleeding risk if NSAID use is essential.
Combining meloxicam with ticagrelor significantly increases your risk of serious bleeding, including stomach bleeding. Your doctor may need to adjust your medications or monitor you closely.
Mechanism
Meloxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal protection and inhibit platelet aggregation. Ticagrelor is a potent antiplatelet agent that directly inhibits platelet aggregation. The combined antiplatelet effects and gastrointestinal mucosal damage synergistically increase bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, which can be severe or life-threatening. This combination can increase the risk of major bleeding events by several-fold compared to either drug alone, potentially leading to anemia, hematemesis, melena, or hemorrhagic stroke. This combination should generally be avoided due to the high bleeding risk. If concurrent use is absolutely necessary, the lowest effective dose of meloxicam for the shortest duration should be used, along with a proton pump inhibitor (PPI) for gastroprotection. Close monitoring for signs of bleeding is essential, and alternative pain management strategies should be explored.
Combining diclofenac with ticagrelor significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided due to the heightened risk of serious bleeding events.
Mechanism
Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal protection and prolong bleeding time. Ticagrelor is an antiplatelet agent that prevents platelet aggregation. The concurrent use of these two drugs leads to additive antiplatelet effects and increased gastrointestinal toxicity, thereby substantially raising the risk of bleeding.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, particularly gastrointestinal bleeding (e.g., ulcers, hemorrhage), but also other forms of bleeding such as epistaxis, hematuria, and bruising. The risk of major bleeding can be several-fold higher compared to ticagrelor alone, potentially leading to hospitalization, transfusions, or even fatal outcomes. This combination should be avoided if possible. If an NSAID is absolutely necessary, consider alternative pain management strategies or a short course of a COX-2 selective NSAID with careful monitoring and gastric protection (e.g., proton pump inhibitor). Closely monitor for any signs of bleeding (e.g., black/tarry stools, coffee-ground vomit, unusual bruising).
Combining ketorolac with ticagrelor significantly increases your risk of bleeding, including serious and life-threatening events such as stomach bleeding or stroke.
Mechanism
Ketorolac, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Ticagrelor is an antiplatelet agent that directly inhibits the P2Y12 ADP receptor on platelets, preventing their activation and aggregation. The concurrent use of these agents results in a synergistic inhibition of platelet function and disruption of the gastrointestinal mucosal barrier, markedly increasing bleeding risk.
Clinical Management
This combination carries a high risk of severe bleeding, including gastrointestinal hemorrhage, intracranial hemorrhage, and other major bleeding events. Patients may experience symptoms like black, tarry stools, vomiting blood, unusual bruising, or prolonged bleeding from cuts. The absolute risk of major bleeding can be substantially elevated, potentially exceeding 2-3 times compared to ticagrelor alone. Concomitant use of ketorolac and ticagrelor should generally be avoided due to the high risk of major bleeding. If an NSAID is absolutely necessary, consider alternatives with lower GI risk, such as celecoxib, and use for the shortest duration possible, while closely monitoring for signs of bleeding. Proton pump inhibitor (PPI) co-therapy is recommended if an NSAID must be used. Consider alternative pain management strategies that do not affect platelet function.
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