Ticagrelor(274693-27-5) is a platelet aggregation inhibitor, It keeps the platelets in your blood from coagulating (clotting) to prevent unwanted blood clots. Visit: http://www.aasraw.com/products/ticagrelor-powder/

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Platelet Aggregation Inhibitor Ticagrelor(274693-27-5)
For Sale
Platelet Aggregation Inhibitor Ticagrelor(274693-27-5) For Sale.......................................................1
1. Ticagrelor(274693-27-5)..................................................................................................................1
2. Ticagrelor Brand Name: Brilinta................................................................................................2
3. Ticagrelor: Mechanism Of Action....................................................................................................3
4. How does ticagrelor(Brilinta) work?............................................................................................... 5
5. Ticagrelor--Clinical Trials..................................................................................................................5
(1) Clinical efficacy of Ticagrelor................................................................................................. 5
(2) Conclusion..............................................................................................................................6
6. What is the drug ticagrelor used for?............................................................................................. 9
7. How to take Ticagrelor(Brilinta) reasonably?................................................................................. 9
(1) Ticagrelor(Brilinta) dosing information................................................................................. 9
(2) How is this Ticagrelor best taken?.......................................................................................11
(3) How should I take ticagrelor (Brilinta)?...............................................................................13
(4) What should I avoid while taking ticagrelor(Brilinta)?........................................................14
8. Ticagrelor Side Effects................................................................................................................... 14
9. What other drugs will affect ticagrelor?.......................................................................................16
10. What should I know about storage and disposal of this medication?....................................... 17
11. What is the most important information I should know about ticagrelor (Brilinta)?................18
12. Where can I get more information?............................................................................................20
1. Ticagrelor(274693-27-5)
Ticagrelor (trade name Brilinta in the US, Brilique and Possia in the EU) is a
platelet aggregation inhibitor produced by AstraZeneca. Unlike clopidogrel,
ticagrelor is not a prodrug and does not require metabolic
activation. Ticagrelor is used along with aspirin to prevent serious or
life-threatening problems with the heart and blood vessels in people who

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have had a heart attack or severe chest pain. It is also used to prevent blood
clots from forming in people with coronary stents (metal tubes surgically
placed in clogged blood vessels to improve blood flow) who have had a heart
attack or severe chest pain. Ticagrelor is in a class of medications called
antiplatelet medications. It works by preventing platelets (a type of blood cell)
from collecting and forming clots that may cause a heart attack or stroke.
2. Ticagrelor Brand Name: Brilinta
Ticagrelor is a crystalline powder with an aqueous solubility of approximately
10 mcg/mL at room temperature.

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Brilinta tablets for oral administration contain 90 mg of ticagrelor and the
following ingredients: mannitol, dibasic calcium phosphate, sodium starch
glycolate, hydroxypropyl cellulose, magnesium stearate, hydroxypropyl
methylcellulose, titanium dioxide, talc, polyethylene glycol 400, and ferric
oxide yellow.
3. Ticagrelor: Mechanism Of Action
Ticagrelor(Brilinta), a member of the new chemical class
cyclopentyltriazolopyrimidines (CPTP), which is a oral, direct acting, selective
and reversibly binding P2Y12 receptor antagonist that prevents adenosine
diphosphate (ADP)-mediated P2Y12 platelet activation and aggregation.

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Ticagrelor does not prevent ADP binding, but when bound to the P2Y12
receptor prevents ADP-induced signal transduction.
Since platelets participate in the initiation and/or evolution of thrombotic
complications of atherosclerotic disease, inhibition of platelet function has
been shown to reduce the risk of cardiovascular events such as death,
myocardial infarction or stroke.
Ticagrelor has an additional mechanism of action, increasing local
endogenous adenosine levels by inhibiting equilibrative nucleoside
transporter-1 (ENT-1). Adenosine is formed locally at sites of hypoxia and
tissue damage through degradation of released adenosine tri- and
di-phosphate (ATP and ADP). As adenosine degradation is essentially
restricted to the intracellular space, inhibition of ENT-1 by ticagrelor prolongs
the half-life of adenosine and thereby increases its local extracellular
concentration providing enhanced local adenosine responses. Ticagrelor has
no clinically significant direct effect on adenosine receptors (A1, A2A, A2B, A3)
and is not metabolised to adenosine. Adenosine has been documented to
have a number of effects that include: vasodilation, cardioprotection, platelet
inhibition, modulation of inflammation and induction of dyspnoea, which
may contribute to the clinical profile of ticagrelor.

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4. How does ticagrelor(Brilinta) work?
Ticagrelor(Brilinta)reversibly inhibits the platelet adenosine diphosphate (ADP)
P2Y12 receptors which results in rapid inhibition of platelet activation and
aggregation. Clopidogrel also acts on these receptors, however, because it is
a “prodrug”, the transformation to the active metabolite tends to result in
slower and less consistent inhibition of platelets than with
ticagrelor(Brilinta).3, 5 The transformation of clopidogrel to its active
metabolite requires the enzyme CYP2C19. Approximately 30–40% of people
of M ā ori, Pacific and Asian ethnicity have reduced function CYP2C19
polymorphisms, compared to 15% of Europeans. Although it is not yet
proven, ticagrelor(Brilinta) may be of particular benefit, compared with
clopidogrel, for people in these ethnic groups (Māori, Pacific and Asian).
5. Ticagrelor--Clinical Trials
(1) Clinical efficacy of Ticagrelor
The efficacy and safety of ticagrelor have been evaluated by Platelet
inhibition and Patient Outcomes (PLATO) phase-III trial. The PLATO trial was
performed in patients with either non-ST elevation or ST-elevation ACS. A
total of 18,624 patients were randomly assigned to receive either ticagrelor

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(180 mg loading dose, 90 mg twice daily thereafter) or clopidrogel (300-600
mg loading dose, 75 mg thereafter) along with aspirin (75-100 mg per day)
for 12 months. The primary efficacy outcome was the death from
cardiovascular causes. Myocardial infarction or stroke was significantly
reduced among patients who received ticagrelor compared with those who
took clopidrogel (9.8% versus 11.7%; hazard ratio (HR) 0.84, P < 0.001).
However, one group of patients enrolled in United States fared worse with
ticagrelor as compared of clopidrogel (hazard ratio 1.27 as compared to
hazard ratio for non US patients: 0.81). PLATO data showed that aspirin
dosage was ≥300 mg in this subgroup of patients and that might be reason
for this type of response.
(2) Conclusion
In view of the overall health impact of ACS, as well as its significant economic
burden, P&T decision makers need to identify optimal treatment approaches
to this debilitating and potentially fatal disorder.
Ticagrelor(Brilinta) is the first cyclopentyltriazolopyridine in a new class of
antiplatelets. Ticagrelor interacts with the P2Y12 ADP receptor, which is

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approved for the reduction of thrombotic cardiovascular events in patients
with ACS. Ticagrelor is not a prodrug and does not require metabolic
activation to inhibit the P2Y12 receptor; however, hepatic metabolism is
needed to produce its active metabolite.
In the pivotal phase-3 PLATO trial, Ticagrelor(Brilinta) significantly reduced
the rate of first occurrence of the study ’ s composite end point of
cardiovascular death, nonfatal MI (excluding silent MI), or stroke versus
clopidogrel. Ticagrelor also reduced the secondary end points of
cardiovascular death and MI individually, with no difference in stroke versus
clopidogrel.

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Ticagrelor(Brilinta) has been studied in ACS in combination with aspirin.
Maintenance doses of aspirin above 100 mg decreased the effectiveness of
Ticagrelor. Maintenance doses of aspirin above 100 mg should be avoided.
Like other antiplatelet agents, Ticagrelor can cause significant, sometimes
fatal, bleeding. Ticagrelor should not be used in patients with active
pathological bleeding or a history of intracranial hemorrhage. Ticagrelor
should not be started in patients planned to undergo urgent CABG surgery.
When possible, discontinue Ticagrelor at least 5 days prior to any surgery.
Suspect bleeding in any patient who is hypotensive and has recently
undergone coronary angiography, PCI, CABG, or other surgical procedures in
the setting of Ticagrelor. If possible, manage bleeding without discontinuing
Ticagrelor. Stopping Ticagrelor increases the risk of subsequent
cardiovascular events.
Ticagrelor(Brilinta) is contraindicated in patients with a history of intracraial
hemorrhage and active pathological bleeding, such as peptic ulcer. Ticagrelor
is also contraindicated in patients with severe hepatic impairment because of
a probable increase in exposure. Ticagrelor has not been studied in these
patients. Severe hepatic impairment increases the risk of bleeding because of
reduced synthesis of coagulation proteins.

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The clinical use of Ticagrelor is supported by a Risk Evaluation and Mitigation
Strategy (REMS) initiative, which is designed to inform health care
professionals and patients about the risks associated with Ticagrelor,
particularly the risk of bleeding, and about the need to ensure that the
maintenance dose of aspirin, co-administered with Ticagrelor, does not
exceed 100 mg.
6. What is the drug ticagrelor used for?
♦ Ticagrelor use: It is used to lower the chance of heart attack, stroke, and
death in some people.
♦ Ticagrelor use: It is used to lower the chance of blockage of a stent after a
stent is placed in the heart.
♦ Ticagrelor use: It may be given to you for other reasons. Talk with the
doctor.
7. How to take Ticagrelor(Brilinta) reasonably?
(1) Ticagrelor(Brilinta) dosing information

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Usual Adult Dose for Acute Coronary Syndrome:
Following an acute coronary syndrome (ACS) event:
Loading dose: 180 mg orally once
Maintenance dose: 90 mg orally twice a day for 1 year
Maintenance dose after 1 year: 60 mg orally twice a day
Comments:
-This drug should be taken in conjunction with a daily maintenance dose of
aspirin 75 to 100 mg orally once a day.
-For at least the first 12 months following ACS, this drug is superior to
clopidogrel.
Uses:
-To reduce the rate of cardiovascular death, myocardial infarction, and stroke
in patients with acute coronary syndrome (ACS) or a history of myocardial
infarction.
-To reduce the rate of stent thrombosis in patients who have been stented
for treatment of ACS.

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Usual Adult Dose for Prevention of Atherothrombotic Events:
Following an acute coronary syndrome (ACS) event:
Loading dose: 180 mg orally once
Maintenance dose: 90 mg orally twice a day for 1 year
Maintenance dose after 1 year: 60 mg orally twice a day
Comments:
-This drug should be taken in conjunction with a daily maintenance dose of
aspirin 75 to 100 mg orally once a day.
-For at least the first 12 months following ACS, this drug is superior to
clopidogrel.
Uses:
-To reduce the rate of cardiovascular death, myocardial infarction, and stroke
in patients with acute coronary syndrome (ACS) or a history of myocardial
infarction.
-To reduce the rate of stent thrombosis in patients who have been stented
for treatment of ACS.
(2) How is this Ticagrelor best taken?

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Use ticagrelor as ordered by your doctor. Read all information given to you.
Follow all instructions closely.
♦ Take ticagrelor at the same time of day.
♦ Take with or without food.
♦ If you cannot swallow the tablet whole, the tablet can be crushed and
mixed with water.
♦ Drink right away after mixing. Refill the glass with water, stir, and drink.
♦Those who have feeding tubes may use the tablet. Crush the tablet and mix
it with water.
♦ Flush the feeding tube after ticagrelor is given.
♦ To gain the most benefit, do not miss doses.
♦ Keep taking ticagrelor as you have been told by your doctor or other health
care provider, even if you feel well.
What do I do if I miss a ticagrelor dose?
♦ Skip the missed ticagrelor dose and go back to your normal time.
♦ Do not take 2 ticagrelor doses at the same time or extra doses.

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(3) How should I take ticagrelor (Brilinta)?
Take exactly as prescribed by your doctor. Do not take in larger or smaller
amounts or for longer than recommended. Follow the directions on your
prescription label.
Ticagrelor should be taken together with aspirin. Follow your doctor's
instructions about how much aspirin you should take. Ticagrelor can be taken
with or without food. Take the medicine at the same time each day.
Because ticagrelor keeps your blood from coagulating (clotting) to prevent
unwanted blood clots, this medicine can also make it easier for you to bleed,
even from a minor injury. Contact your doctor or seek emergency medical
attention if you have any bleeding that will not stop.
If you need surgery or dental work, tell the surgeon or dentist ahead of time
that you are using ticagrelor. You may need to stop using the medicine for at
least 5 days before having surgery, to prevent excessive bleeding. Follow your
doctor's instructions and start taking ticagrelor again as soon as possible.
Do not stop taking ticagrelor without first talking to your doctor, even if you
have signs of bleeding. Use ticagrelor regularly to get the most benefit. Get
your prescription refilled before you run out of medicine completely.

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Stopping ticagrelor may increase your risk of a heart attack or stroke. Store at
room temperature away from moisture and heat.
(4) What should I avoid while taking ticagrelor(Brilinta)?
Drinking alcohol while taking aspirin can increase your risk of stomach
bleeding.
Avoid activities that may increase your risk of bleeding or injury. Use extra
care to prevent bleeding while shaving or brushing your teeth.
While taking ticagrelor with aspirin, avoid using medicines for pain, fever,
swelling, or cold/flu symptoms. They may contain ingredients similar to
aspirin (such as salicylates, ibuprofen, ketoprofen, or naproxen). Taking
certain products together can cause you to get too much aspirin which can
increase your risk of bleeding.
8. Ticagrelor Side Effects
WARNING/CAUTION: Even though it may be rare, some people may have
very bad and sometimes deadly ticagrelor side effects when taking ticagrelor.
Tell your doctor or get medical help right away if you have any of the

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following signs or symptoms that may be related to a very bad ticagrelor side
effect:
♦ Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered,
or peeling skin with or without fever; wheezing; tightness in the chest or
throat; trouble breathing, swallowing, or talking; unusual hoarseness; or
swelling of the mouth, face, lips, tongue, or throat.
♦ Signs of bleeding like throwing up blood or throw up that looks like coffee
grounds; coughing up blood; blood in the urine; black, red, or tarry stools;
bleeding from the gums; vaginal bleeding that is not normal; bruises without
a reason or that get bigger; or any bleeding that is very bad or that you
cannot stop.
♦ Weakness on 1 side of the body, trouble speaking or thinking, change in
balance, drooping on one side of the face, or blurred eyesight.
♦ Very bad headache.
♦ Shortness of breath.
♦ Slow heartbeat.
♦ A heartbeat that does not feel normal.

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9. What other drugs will affect ticagrelor?
Sometimes it is not safe to use certain medications at the same time. Some
drugs can affect your blood levels of other drugs you take, which may
increase side effects or make the medications less effective.
Tell your doctor about all your current medicines. Many drugs can interact
with ticagrelor, especially:
♦ antifungal medicine;
♦ antiviral medicine to treat HIV or AIDS;
♦ a blood thinner;

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♦ cholesterol medication;
♦ heart or blood pressure medication;
♦ opioid medication;
♦ seizure medicine; or
♦ tuberculosis medicine.
10. What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of
reach of children. Store it at room temperature and away from excess heat
and moisture (not in the bathroom).
Unneeded medications should be disposed of in special ways to ensure that
pets, children, and other people cannot consume them. However, you should
not flush this medication down the toilet. Instead, the best way to dispose of
your medication is through a medicine take-back program. Talk to your
pharmacist or contact your local garbage/recycling department to learn
about take-back programs in your community. See the FDA's Safe Disposal of
Medicines website for more information if you do not have access to a
take-back program.

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It is important to keep all medication out of sight and reach of children as
many containers (such as weekly pill minders and those for eye drops, creams,
patches, and inhalers) are not child-resistant and young children can open
them easily. To protect young children from poisoning, always lock safety
caps and immediately place the medication in a safe location – one that is
up and away and out of their sight and reach.
11. What is the most important information I should know about
ticagrelor (Brilinta)?
Ticagrelor keeps your blood from coagulating (clotting) to prevent unwanted
blood clots that can occur with certain heart or blood vessel conditions.
Because of this drug action, ticagrelor can make it easier for you to bleed,

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even from a minor injury. Contact your doctor or seek emergency medical
attention if you have bleeding that will not stop.
You may also have bleeding on the inside of your body, such as in your
stomach or intestines. Call your doctor at once if you have black or bloody
stools, or if you cough up blood or vomit that looks like coffee grounds.
These could be signs of bleeding in your digestive tract.
While you are taking ticagrelor, do not take aspirin or other NSAIDs
(non-steroidal anti-inflammatory drugs) without your doctor's advice. NSAIDs
include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan,
Treximet), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), indomethacin
(Indocin), meloxicam (Mobic), and others.
Ticagrelor may cause you to bleed more easily, especially if you have: a
history of bleeding problems, surgery or a medical emergency, a disease
affecting the blood vessels in your brain, a history of stomach or intestinal
bleeding, or if you are 65 or older.
Many drugs (including some over-the-counter medicines and herbal
products) can interact with ticagrelor. It is very important to tell your doctor
about all medicines you have recently used. Ask your doctor before taking
any medicine for pain, arthritis, fever, or swelling. These medicines may affect

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blood clotting and may also increase your risk of stomach bleeding. Any
doctor, dentist, surgeon, or other medical care provider who treats you
should know that you are taking ticagrelor.
12. Where can I get more information?
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the
indication prescribed.
Every effort has been made to ensure that the information provided
by AASraw up-to-date, and complete, but no guarantee is made to that
effect. Drug information contained herein may be time sensitive.
AASraw information has been compiled for use by healthcare practitioners
and consumers in the United States and therefore AASraw does not warrant
that uses outside of the United States are appropriate, unless specifically
indicated otherwise. AASraw's drug information does not endorse drugs,
diagnose patients or recommend therapy. AASraw's drug information is an
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caring for their patients and/or to serve consumers viewing this service as a
supplement to, and not a substitute for, the expertise, skill, knowledge and

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judgment of healthcare practitioners. The absence of a warning for a given
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information contained herein is not intended to cover all possible uses,
directions, precautions, warnings, drug interactions, allergic reactions, or
adverse effects. If you have questions about the drugs you are taking, check
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