Dosing and uses of Ticlid (ticlopidine)
Adult dosage forms and strengths
tablet
- 250mg
Stroke
250 mg PO q12hr with food
Coronary Artery Stent Thrombosis, Prevention
250 mg PO q12hr with aspirin for 30 days Or
ACCP: Load 500 mg, THEN 250 mg q12hr for at least 10-14 days following successful stent placement
Renal Impairment
Dose adjustment not necessary
Hepatic Impairment
Caution; contraindicated in severe hepatic impairment
Other Information
Monitor: CBC, LFT's prior to starting & q2Weeks for first 3 months
Other Indications & Uses
Reduce risk of thrombotic stroke: only in patients allergic to ASA or who failed ASA; prevention of coronary artery stent thrombosis
Off-label: CABG, chronic arterial occlusion, glomerulonephritis, intermittent claudication, open heart surgery, sickle cell disease, unstable angina
Pediatric dosage forms and strengths
<18 years old: safety & efficacy not established
Geriatric dosage forms and strengths
Causes orthostatic hypotension and more effective alternatives available (Beers criteria)
Stroke
250 mg PO q12hr with food; monitor (greater sensitivity possible)
Coronary artery stent thrombosis, prevention
250 mg PO q12hr with food; monitor (greater sensitivity possible)
Ticlid (ticlopidine) adverse (side) effects
>10%
Diarrhea (12.5%)
1-10%
Elevated alkaline phosphatase (7.6%)
Nausea (7%)
Dyspepsia (7%)
Rash (5%)
GI pain (3.7%)
Elevated AST/SGOT (3.1%)
Neutropenia (2.4%)
Purpura (2.2%)
Vomiting (1.9%)
Flatulence (1.5%)
Pruritus (1.3%)
Dizziness (1%)
Abnormal LFTs (1%)
Anorexia (1%)
<1%
Agranulocytosis
Aplastic anemia
Pancytopenia
TTp
Warnings
Black box warnings
May cause life-threatening hematologic events, including neutropenia, agranulocytosis, thrombocytopenia purpura, and aplastic anemia
Contraindications
Documented hypersensitivity
Neutropenia, thrombocytopenia, hemostatic disorder or active bleeding (GI bleed, ICH), severe hepatic impairment, history of either thrombotic thrombocytopenic purpura (TTP) or aplastic anemia
Current use of other anticoagulant drugs
Cautions
Due to risk of adverse hematologic events, for stroke prevention use only in ASA-intolerant patients
Patients with lesions that have a propensity to bleed
Discontinue 10-14 days before elective major surgery in patients with bleeding diathesis
Increases serum chlesterol & triglyceride concentrations
Long-term use with concurrent aspirin not recommended
Pregnancy and lactation
Pregnancy category: B
Lactation: not known whether excreted in breast milk, discontinue drug or do not nurse
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Ticlid (ticlopidine)
Mechanism of action
Platelet aggregation inhibitor; reversibly interacts with the platelet P2Y12 ADP-receptor to prevent signal transduction and platelet activation
Pharmacokinetics
Peak Plasma: 2 hr
Onset of action: 6 hr
Absorption: >80%
Half-Life elimination: 13 hr
Max Effect: 8-11 days postinitiation
Protein Bound: 98%
Metabolism: Liver
Excretion: Urine (60%); feces (23%)
