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| __NOTOC__
| | #REDIRECT [[Ticagrelor#Warnings]] |
| {{Ticagrelor}}
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| {{CMG}}; {{AE}} {{JH}}
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| ==Warnings and Precautions==
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| ===General Risk of Bleeding===
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| Drugs that inhibit [[platelet]] function including BRILINTA increase the risk of bleeding. BRILINTA increased the overall risk of bleeding (Major + Minor) to a somewhat greater extent than did [[clopidogrel]]. The increase was seen for non-[[CABG]]-related bleeding, but not for [[CABG]]-related bleeding. Fatal and life-threatening bleeding rates were not increased ''[see [[Ticagrelor adverse reactions|Adverse Reactions]]]''.
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| In general, risk factors for bleeding include older age, a history of bleeding disorders, performance of percutaneous invasive procedures, and concomitant use of medications that increase the risk of bleeding (e.g., [[anticoagulant]] and [[fibrinolytic therapy]], higher doses of aspirin, and chronic [[nonsteroidal anti-inflammatory drugs]] [NSAIDS]).
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| When possible, discontinue BRILINTA five days prior to surgery. Suspect bleeding in any patient who is [[hypotension|hypotensive]] and has recently undergone [[coronary angiography]], [[PCI]], [[CABG]], or other surgical procedures, even if the patient does not have any signs of bleeding.
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| If possible, manage bleeding without discontinuing BRILINTA. Stopping BRILINTA increases the risk of subsequent cardiovascular events ''[see [[Ticagrelor warnings and precautions|Warnings and Precautions]] and [[Ticagrelor adverse reactions|Adverse Reactions]]]''.
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| ===Concomitant Aspirin Maintenance Dose===
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| In PLATO, use of BRILINTA with maintenance doses of [[aspirin]] above 100 mg decreased the effectiveness of BRILINTA. Therefore, after the initial loading dose of [[aspirin]] (usually 325 mg), use BRILINTA with a maintenance dose of [[aspirin]] of 75-100 mg ''[see [[Ticagrelor dosage and administration|Dosage and Administration]] and [[Ticagrelor clinical studies|Clinical Studies]]]''.
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| ===Moderate Hepatic Impairment===
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| BRILINTA has not been studied in patients with moderate [[hepatic impairment]]. Consider the risks and benefits of treatment, noting the probable increase in exposure to ticagrelor.
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| ===Dyspnea===
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| In PLATO, [[dyspnea]] was reported in 14% of patients treated with BRILINTA and in 8% of patients taking [[clopidogrel]]. [[Dyspnea]] was usually mild to moderate in intensity and often resolved during continued treatment, but occasionally required discontinuation (0.9% of patients taking BRILINTA versus 0.1% of patients taking [[clopidogrel]]). If a patient develops new, prolonged, or worsened [[dyspnea]] during treatment with BRILINTA, exclude underlying diseases that may require treatment. If dyspnea is determined to be related to BRILINTA, no specific treatment is required; continue BRILINTA without interruption. In the case of intolerable [[dyspnea]] requiring discontinuation of BRILINTA, consider prescribing another [[antiplatelet agent]].
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| In a substudy, 199 patients from PLATO underwent pulmonary function testing irrespective of whether they reported [[dyspnea]]. There was no significant difference between treatment groups for [[FEV1]]. There was no indication of an adverse effect on pulmonary function assessed after one month or after at least 6 months of chronic treatment.
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| ===Discontinuation of BRILINTA===
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| Avoid interruption of BRILINTA treatment. If BRILINTA must be temporarily discontinued (e.g., to treat bleeding or for elective surgery), restart it as soon as possible.
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| Discontinuation of BRILINTA will increase the risk of [[myocardial infarction]], [[stent thrombosis]], and death.
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| ===Strong Inhibitors of Cytochrome CYP3A===
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| Ticagrelor is metabolized by [[CYP3A]]4/5. Avoid use with strong CYP3A inhibitors, such as [[atazanavir]], [[clarithromycin]], [[indinavir]], [[itraconazole]], [[ketoconazole]], [[nefazodone]], [[nelfinavir]], [[ritonavir]], [[saquinavir]], [[telithromycin]] and [[voriconazole]] ''[see [[Ticagrelor drug interactions|Drug Interactions]] and [[Ticagrelor clinical pharmacology|Clinical Pharmacology]]]''.
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| ===Cytochrome CYP3A Potent Inducers===
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| Avoid use with potent [[CYP3A]] inducers, such as [[rifampin]], [[dexamethasone]], [[phenytoin]], [[carbamazepine]], and [[phenobarbital]] ''[see [[Ticagrelor drug interactions|Drug Interactions]] and [[Ticagrelor clinical pharmacology|Clinical Pharmacology]]]''. <ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = BRILINTA (TICAGRELOR) TABLET [ASTRAZENECA LP] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f7b3f443-e83d-4bf2-0e96-023448fed9a8 | publisher = | date = | accessdate = }}</ref>
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| ==References==
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| {{Reflist}}
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| [[Category:ADP receptor inhibitors]]
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| [[Category:Cardiovascular Drugs]]
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| [[Category:Drugs]]
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