Gretor 90 Drug Interactions

CYP3A Inhibitors: Strong CYP3A inhibitors substantially increase ticagrelor exposure and so increase the risk of dyspnea, bleeding, and other adverse events. Avoid use of strong inhibitors of CYP3A (e.g. ketoconazole, itraconazole, voriconazole, clarithromycin, nefazodone, ritonavir, saquinavir, nelfinavir, indinavir, atazanavir and telithromycin) with Ticagrelor. Moderate CYP3A inhibitors such as amprenavir, aprepitant, diltiazem, erythromycin, fluconazole, and verapamil can be co-administered with Ticagrelor. Cyclosporine (PgP and CYP3A Inhibitor) increases exposure to Ticagrelor while not affecting cyclosporine blood levels.
Strong CYP3A Inducers: Strong CYP3A inducers substantially reduce ticagrelor exposure and so decrease the efficacy of ticagrelor. Avoid use with strong inducers of CYP3A (e.g., rifampin, phenytoin, carbamazepine and phenobarbital).
Aspirin, Enoxaparin and Heparin: Co-administration of Ticagrelor with heparin, enoxaparin, and aspirin do not have any effect on Ticagrelor or the active metabolite plasma levels. Ticagrelor had no effect on heparin based on activated partial thromboplastin time (aPTT) and activated coagulation time (ACT) assays. Ticagrelor had no effect on enoxaparin based on factor Xa assay. Also, co-administration of Ticagrelor and high maintenance dose ASA (>300 mg) is not recommended.
Tolbutamide and Warfarin: Since Ticagrelor is not a CYP2C9 inhibitor, it is unlikely to alter the CYP2C9-mediated metabolism of drugs such as tolbutamide and warfarin.
Opioids: As with other oral P2Y12 inhibitors, co-administration of opioid agonists delays and reduce the absorption of ticagrelor and its active metabolite presumably because of slowed gastric emptying. Consider the use of a parenteral anti-platelet agent in acute coronary syndrome patients requiring co-administration of morphine or other opioid agonists.
Simvastatin, Lovastatin, and Atorvastatin: Ticagrelor increases serum concentrations of simvastatin, lovastatin, and atorvastatin because these drugs are metabolized by CYP3A4. Avoid simvastatin and lovastatin doses greater than 40.
Digoxin: Ticagrelor inhibits the P-glycoprotein transporter; monitor digoxin levels with initiation of or change in ticagrelor therapy.
Oral Contraceptives: Co-administration of Ticagrelor with oral contraceptives (levonorgestrel and ethinyl estradiol) increases exposure of ethinyl estradiol exposure but do not alter the PK of levonorgestrel. No clinically significant effect on oral contraceptives is expected when administered with Ticagrelor.