Agraplat Special Precautions

General Risk of Bleeding: Drugs that inhibit platelet function including Ticagrelor increase the risk of bleeding. If possible, manage bleeding without discontinuing Ticagrelor. Stopping Ticagrelor increases the risk of subsequent cardiovascular events.
Concomitant Aspirin Maintenance Dose: In PLATO the use of Ticagrelor with maintenance doses of aspirin above 100 mg decreased the effectiveness of Ticagrelor. Therefore, after the initial loading dose of aspirin, use Ticagrelor with a maintenance dose of aspirin of 75-100 mg.
Dyspnea: If a patient develops new, prolonged, or worsened dyspnea that is determined to be related to Ticagrelor, no specific treatment is required; continue Ticagrelor without interruption if possible. In the case of intolerable dyspnea requiring discontinuation of Ticagrelor, consider prescribing another antiplatelet agent.
Discontinuation of Ticagrelor: Discontinuation of Ticagrelor will increase the risk of myocardial infarction, stroke, and death. If Ticagrelor must be temporarily discontinued (e.g., to treat bleeding or for significant surgery), restart it as soon as possible. When possible, interrupt therapy with Ticagrelor for five days prior to surgery that has a major risk of bleeding. Resume Ticagrelor as soon as hemostasis is achieved.
Severe Hepatic Impairment: Avoid use of Ticagrelor in patients with severe hepatic impairment. Severe hepatic impairment is likely to increase serum concentration of Ticagrelor. There are no studies of Ticagrelor patients with severe hepatic impairment.
Hepatic Impairment: Ticagrelor is metabolized by the liver and impaired hepatic function can increase risks for bleeding and other adverse events. Avoid use of Ticagrelor in patients with severe hepatic impairment. There is limited experience with Ticagrelor in patients with moderate hepatic impairment; consider the risks and benefits of treatment, noting the probable increase in exposure to Ticagrelor. No dosage adjustment is needed in patients with mild hepatic impairment.
Renal Impairment: No dosage adjustment is needed in patients with renal impairment. Patients receiving dialysis have not been studied.
Effects On Ability to Drive and Use Machine: There are no data on the effects of Ticagrelor on the ability to drive or use machines.
Use in Children: The safety and effectiveness of Ticagrelor in pediatric patients have not been established.