Antiplatelet agent

CCP: Adjunctive antiplatelet therapy for STEMI

• Hypersensitivity to ticagrelor or any component
• Active pathological bleeding (e.g., peptic ulcer, intracranial hemorrhage) or history of intracranial hemorrhage
• Moderate to severe hepatic impairment
• Concurrent use of strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir, atazanavir, nefazodone)

Following oral administration:

• Onset: within 30 minutes
• Peak: 2 hours
• Duration: 2-8 hours
• Half-life: 7 hours (9 hours for active metabolite)
• Elimination: feces and urine

> 10%:

• Respiratory: Dyspnea (14-21%)

1-10%:

• Cardiovascular: ECG abnormality (ventricular pause; 2-6%)
• Endocrine & metabolic: Gout (≤2%)
• Gastrointestinal: Nausea (4%)
• Hematologic & oncologic: Major hemorrhage (4%), minor hemorrhage (4%)
• Nervous system: Dizziness (5%)
• Renal: Increased serum creatinine (7%; transient; mechanism undetermined)
• Endocrine & metabolic: Increased uric acid (frequency not defined)

• Ticagrelor increases the risk of bleeding, including significant and sometimes fatal bleeding.  Use is contraindicated in patients with active pathological bleeding (e.g., active peptic ulcer, intracranial hemorrhage) or history of intracranial hemorrhage. 
• Additional risk factors for bleeding include: propensity to bleed (e.g., recent trauma or surgery, recent or recurrent GI bleeding, active peptic ulcer disease [PUD], moderate to severe hepatic impairment); coronary artery bypass graft (CABG), or other surgical procedure; concomitant use of medications that increase risk of bleeding (e.g., warfarin, nonsteroidal anti-inflammatory drugs); and advanced age.
• Occult hemorrhage should be suspected if the patient becomes hypotensive after undergoing recent coronary angiography, percutaneous coronary intervention, CABG, or other surgical procedure even if overt signs of bleeding do not exist.