Gretor 90 Special Precautions

Risk of Bleeding: Drugs that inhibit platelet function including ticagrelor increase the risk of bleeding. Patient with a propensity to bleed (e.g., due to recent trauma, recent surgery, active or recent GI bleeding, or moderate hepatic impairment) should use Ticagrelor with caution. If possible, manage bleeding without discontinuing ticagrelor. Stopping ticagrelor increases the risk of subsequent cardiovascular events. Consideration should be given to patients with concomitant administration of medicinal products that may increase the risk of bleeding (e.g. non-steroidal anti-inflammatory drugs (NSAIDs), oral anticoagulants, and/or fibrinolytics within 24 hours of ticagrelor dosing. Platelet infusion do not reverse the antiplatelet effect of Ticagrelor in patients with bleeding. Co-administration of Ticagrelor with Desmopressin did not decrease template bleeding time, desmopressin is unlikely to be effective in managing clinical bleeding events. Aminocaproic acid and Tranexamic acid and/or recombinant factor VIIa may augment homeostasis.
Surgery: Because of the reversible binding, restoration of platelet aggregation occurs faster with Ticagrelor. The more rapid offset of effect may predict a reduced risk of bleeding complications (in settings where antiplatelet therapy must be temporarily discontinued due to surgery or trauma). If a patient has to undergo elective surgery and antiplatelet effect is desired, Ticagrelor should be discontinued 5 days prior to surgery.
Patients with Prior Ischemic Stroke: ACS patients with prior ischemic stroke may be treated with Ticagrelor for 12 months only. Caution is advised for treatment beyond one year.
Patients with Moderate Hepatic Impairment: Ticagrelor is contraindicated in patients with severe hepatic impairment. Caution is advised in these patients since there is limited experience with the use of Ticagrelor in this population.
Patients At Risk for Bradyarrhythmia: Increased frequency of mostly asymptomatic ventricular pauses during treatment with Ticagrelor has been reported. Patients with an increased risk of bradycardic events (e.g., patients with sick sinus syndrome w/o pacemaker, 2nd or 3rd degree AV block, or bradycardic-related syncope) must use Ticagrelor with caution due to limited clinical experience.
Dyspnea: Dyspnea usually mild to moderate in intensity and often resolved during continued treatment. There was no indication of an adverse effect on pulmonary function assessed after one month or after at least 6 months of chronic treatment. 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.
Thrombotic Thrombocytopenic Purpura: Cases of developing thrombotic thrombocytopenic purpura has been reported very rarely. It is a very serious condition and requires treatment immediately. Use Ticagrelor with caution.
Interference with Laboratory Tests: Use of Ticagrelor may give a false negative result in platelet function test for Heparin-induced thrombocytopenia (HIT). This is related to inhibition of P2Y12-receptor on the healthy donor platelets in the patient's sera/plasma.
Discontinuation of Ticagrelor Tablets: Discontinuation of ticagrelor tablets will increase the risk of myocardial infarction, stroke, and death. If ticagrelor tablets must be temporarily discontinued (e.g., to treat bleeding or for significant surgery), restart it as soon as possible. Resume Ticagrelor tablets as soon as hemostasis is achieved.
Effects on the Ability to Drive and Use Machines: Ticagrelor has no influence on the ability to drive and use machines. During treatment with Ticagrelor, dizziness and confusion have been reported. Therefore, patients who experience these symptoms must exercise caution while driving or using machines.