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TICAGRELOR ASCEND is a brand name for Ticagrelor. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Ticagrelor Ascend, co-administered with acetylsalicylic acid (ASA), is indicated for the prevention of atherothrombotic events in adult patients with - acute coronary syndromes (ACS) or - a history of myocardial infarction (MI) and a high risk of developing an atherothrombotic event (see sections 4.2 and 5.1).
Verbatim from this product's MHRA label. Tap a section to expand.
Posology Patients taking Ticagrelor Ascend should also take a daily low maintenance dose of ASA 75-150 mg, unless specifically contraindicated. Acute coronary syndromes Ticagrelor Ascend treatment should be initiated with a single 180 mg loading dose (two tablets of 90 mg) and then continued at 90 mg twice daily.
1). Discontinuation of ASA may be considered after 3 months in patients with ACS who have undergone a percutaneous coronary intervention (PCI) procedure and have an increased risk of bleeding. 4). 1). Treatment may be started without interruption as continuation therapy after the initial one-year treatment with Ticagrelor Ascend 90 mg or other adenosine diphosphate (ADP) receptor inhibitor therapy in ACS patients with a high risk of an atherothrombotic event.
Treatment can also be initiated up to 2 years from the MI, or within one year after stopping previous ADP receptor inhibitor treatment. There are limited data on the efficacy and safety of ticagrelor beyond 3 years of extended treatment.
If a switch is needed, the first dose of Ticagrelor Ascend should be administered 24 hours following the last dose of the other antiplatelet medication. Missed dose Lapses in therapy should also be avoided. A patient who misses a dose of Ticagrelor Ascend should take only one tablet (their next dose) at its scheduled time.
2). 2). 3). Only limited information is available in patients with moderate hepatic impairment. 2). 2). Paediatric population The safety and efficacy of ticagrelor in children below the age of 18 years have not been established. 2). Method of administration For oral use.
Ticagrelor Ascend can be administered with or without food. For patients who are unable to swallow the tablet(s) whole, the tablets can be crushed to a fine powder and mixed in half a glass of water and drunk immediately. The glass should be rinsed with a further half glass of water and the contents drunk.
The mixture can also be administered via a nasogastric tube (CH8 or greater). It is important to flush the nasogastric tube through with water after administration of the mixture.
8. Central sleep apnoea Central sleep apnoea including Cheyne-Stokes respiration has been reported in the post-marketing setting in patients taking ticagrelor. If central sleep apnoea is suspected, further clinical assessment should be considered.
Creatinine elevations Creatinine levels may increase during treatment with ticagrelor. The mechanism has not been elucidated. Renal function should be checked according to routine medical practice. In patients with ACS, it is recommended that renal function is also checked one month after initiating the treatment with ticagrelor, paying special attention to patients ≥75 years, patients with moderate/severe renal impairment and those receiving concomitant treatment with an angiotensin receptor blocker (ARB).
8). Caution is advised in patients with history of hyperuricaemia or gouty arthritis. As a precautionary measure, the use of ticagrelor in patients with uric acid nephropathy is discouraged. Thrombotic Thrombocytopenic Purpura (TTP) Thrombotic Thrombocytopenic Purpura (TTP) has been reported very rarely with the use of ticagrelor.
It is characterised by thrombocytopenia and microangiopathic haemolytic anaemia associated with either neurological findings, renal dysfunction or fever. TTP is a potentially fatal condition requiring prompt treatment including plasmapheresis.
Interference with platelet function tests to diagnose heparin induced thrombocytopenia (HIT) In the heparin induced platelet activation (HIPA) test used to diagnose HIT, anti- platelet factor 4/heparin antibodies in patient serum activate platelets of healthy donors in the presence of heparin.
False negative results in a platelet function test (to include, but may not be limited to the HIPA test) for HIT have been reported in patients administered ticagrelor. This is related to inhibition of the P2Y12-receptor on the healthy donor platelets in the test by ticagrelor in the patient’s sera/plasma.
1). g. due to recent trauma, recent surgery, coagulation disorders, active or recent gastrointestinal bleeding) or who are at increased risk of trauma. 3). g. non-steroidal anti-inflammatory drugs (NSAIDs), oral anticoagulants and/or fibrinolytics) within 24 hours of ticagrelor dosing.
In two randomised controlled studies (TICO and TWILIGHT) in patients with ACS who have undergone a PCI procedure with a drug-eluting stent, discontinuing ASA after 3 months dual antiplatelet therapy with ticagrelor and ASA (DAPT), and continuing with ticagrelor as single antiplatelet therapy (SAPT) for 9 and 12 months, respectively, has been shown to decrease the risk of bleeding with no observed increase in risk of major adverse cardiovascular events (MACE) compared with continued DAPT.
2). Platelet transfusion did not reverse the antiplatelet effect of ticagrelor in healthy volunteers and is unlikely to be of clinical benefit in patients with bleeding. 5). Antifibrinolytic therapy (aminocaproic acid or tranexamic acid) and/or recombinant factor VIIa therapy may increase haemostasis.
Ticagrelor may be resumed after the cause of bleeding has been identified and controlled. Surgery Patients should be advised to inform physicians and dentists that they are taking ticagrelor before any surgery is scheduled and before any new medicinal product is taken.
8). 1). Patients with prior ischaemic stroke ACS patients with prior ischaemic stroke can be treated with ticagrelor for up to 12 months (PLATO study). In PEGASUS, patients with history of MI with prior ischaemic stroke were not included.
Therefore, in the absence of data, treatment beyond one year is not recommended in these patients. 3). 2). Patients at risk for bradycardic events Holter ECG monitoring has shown an increased frequency of mostly asymptomatic ventricular pauses during treatment with ticagrelor compared with clopidogrel.
8). • Active pathological bleeding. 8). 2). g. 5).
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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Information on concomitant treatment with ticagrelor is required for interpretation of HIT platelet function tests. In patients who have developed HIT, the benefit-risk of continued treatment with ticagrelor should be assessed, taking both the prothrombotic state of HIT and the increased risk of bleeding with concomitant anticoagulant and ticagrelor treatment into consideration.
1). Premature discontinuation Premature discontinuation with any antiplatelet therapy, including Ticagrelor Ascend, could result in an increased risk of cardiovascular (CV) death, MI or stroke due to the patient’s underlying disease.
Therefore, premature discontinuation of treatment should be avoided. Sodium This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say it is essentially 'sodium-free'. 5 Interaction with other medicinal products and other forms of interaction Ticagrelor is primarily a CYP3A4 substrate and a mild inhibitor of CYP3A4.
Ticagrelor is also a P-glycoprotein (P-gp) substrate and a weak P-gp inhibitor and may increase the exposure of P-gp substrates. Ticagrelor is a breast cancer resistance protein (BCRP) inhibitor. 3- fold, respectively. The Cmax and AUC of the active metabolite were reduced by 89% and 56%, respectively.
3). 7-fold and decreased the active metabolite Cmax by 38% and AUC was unchanged. There was no effect of ticagrelor on diltiazem plasma levels. g. amprenavir, aprepitant, erythromycin and fluconazole) would be expected to have a similar effect and can as well be co-administered with ticagrelor.
• A 2-fold increase of ticagrelor exposure was observed after daily consumption of large quantities of grapefruit juice (3x200 ml). This magnitude of increased exposure is not expected to be clinically relevant to most patients. CYP3A inducers Co-administration of rifampicin with ticagrelor decreased ticagrelor Cmax and AUC by 73% and 86%, respectively.
The Cmax of the active metabolite was unchanged and the AUC was decreased by 46%, respectively. g. phenytoin, carbamazepine and phenobarbital) would be expected to decrease the exposure to ticagrelor as well. Co-administration of ticagrelor with potent CYP3A inducers may decrease exposure and efficacy of ticagrelor, therefore, their concomitant use with ticagrelor is discouraged.
8-fold, respectively. The AUC of the active metabolite was increased by 32% and Cmax was decreased by 15% in the presence of cyclosporine. g. verapamil, quinidine) that also may increase ticagrelor exposure. If the association cannot be avoided, their concomitant use should be made with caution.
Others Clinical pharmacology interaction studies showed that co-administration of ticagrelor with heparin, enoxaparin and ASA or desmopressin did not have any effect on the […]
g. patients without a pacemaker who have sick sinus syndrome, 2nd or 3rd degree AV block or bradycardic- related syncope) have been excluded from the main studies evaluating the safety and efficacy of ticagrelor. 1). In addition, caution should be exercised when administering ticagrelor concomitantly with medicinal products known to induce bradycardia.
g. 5). During the Holter substudy in PLATO, more patients had ventricular pauses >3 seconds with ticagrelor than with clopidogrel during the acute phase of their ACS. The increase in Holter-detected ventricular pauses with ticagrelor was higher in patients with chronic heart failure (CHF) than in the overall study population during the acute phase of ACS, but not at one month with ticagrelor or compared to clopidogrel.
1). 8), primarily in patients with ACS, where cardiac ischemia and concomitant drugs reducing the heart rate or affecting cardiac conduction are potential confounders. The patient’s clinical condition and concomitant medication should be assessed as potential causes prior to adjusting treatment.
Dyspnoea Dyspnoea was reported in patients treated with ticagrelor. Dyspnoea is usually mild to moderate in intensity and often resolves without need for treatment discontinuation. Patients with asthma/chronic obstructive pulmonary disease (COPD) may have an increased absolute risk of experiencing dyspnoea with ticagrelor.
Ticagrelor should be used with caution in patients with history of asthma […]