Ticlopidine

Severe: Contraindicated.

Ticlopidine Should be taken with food.

Current or history of haematopoietic disorders (e.g. neutropenia, thrombocytopenia, agranulocytosis, thrombotic thrombocytopenic purpura, aplastic anaemia); haemostatic disorders, active pathological bleeding (e.g. peptic ulcer bleeding, intracranial bleeding). Severe hepatic impairment.

Patient with increased risk of bleeding (e.g. peptic ulcer disease, trauma); previous hypersensitivity to other thienopyridines (e.g. clopidogrel, prasugrel). Consider discontinuation of therapy 10-14 days prior to elective surgery. Renal and mild to moderate hepatic impairment. Elderly. Pregnancy and lactation. Concomitant use with anticoagulants and other platelet aggregation inhibitors.

Significant: Bleeding complications (e.g. bruising, ecchymosis, epistaxis).
Blood and lymphatic system disorders: Pancytopenia, thrombocytopenia.
Gastrointestinal disorders: Diarrhoea, nausea, gastrointestinal pain.
Hepatobiliary disorders: Hepatitis, cholestatic jaundice.
Investigations: Increased alkaline phosphatase and transaminases; increased serum cholesterol and triglycerides.
Nervous system disorders: Headache, dizziness.
Skin and subcutaneous tissue disorders: Rash, pruritus, urticaria. Rarely, Stevens-Johnson syndrome, erythema multiforme.
Potentially Fatal: Haematologic effects, including agranulocytosis, neutropenia, aplastic anaemia, and thrombotic thrombocytopenic purpura.

PO: B

Obtain CBC with differential before initiation and every 1-2 weeks for the 1st 3 or 4 months (more frequently for patients with consistently declining ANC or those with <30% baseline values) and for at least 2 weeks after treatment discontinuation. Monitor LFTs for the 1st 4 months if liver dysfunction is suspected. Assess for signs and symptoms of neutropenia and bleeding.

Increased risk of bleeding with anticoagulants (e.g. warfarin, heparin), other antiplatelet agents, aspirin and NSAIDs. May increase the serum concentrations of theophylline, carbamazepine, and phenytoin. Clearance of ticlopidine may be decreased by cimetidine. May decrease absorption with antacids. May reduce the serum concentration or effects of digoxin and ciclosporin.

May increase bioavailability (by approx 20%) with food.

Description:
Overview: Ticlopidine is a thienopyridine antiplatelet agent.
Mechanism of Action: Ticlopidine undergoes in vivo metabolism into an unidentified active metabolite that irreversibly inhibits the P2Y12 component of adenosine diphosphate (ADP) receptors by blocking the ADP-induced platelet-fibrinogen binding. This action inhibits the activation of GPIIb/IIIa receptor complex, leading to reduced platelet aggregation.
Onset: Approx 6 hours.
Pharmacokinetics:
Absorption: Rapidly and almost completely absorbed from the gastrointestinal tract. Food may increase the bioavailability by approx 20%. Time to peak plasma concentration: Approx 2 hours.
Distribution: Plasma protein binding: Approx 98%, mainly to albumin and lipoproteins; ≤15% to α₁-acid glycoprotein.
Metabolism: Extensively metabolised in the liver into at least 1 active metabolite.
Excretion: Via urine (approx 60% as metabolites); faeces (23%). Elimination half-life: 13 hours.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5472, Ticlopidine. https://pubchem.ncbi.nlm.nih.gov/compound/Ticlopidine. Accessed Oct. 28, 2025.

Store below 30°C. Protect from light.

Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)

B01AC05 - ticlopidine ; Belongs to the class of platelet aggregation inhibitors excluding heparin. Used in the treatment of thrombosis.

Brayfield A, Cadart C (eds). Ticlopidine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/10/2025.

Dyna Tablet 250 mg (Dynapharm [M] Sdn. Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 07/10/2025.

Strokan FC Tablet 250 mg (Duopharm [M] Sdn. Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 07/10/2025.

Ticlopidine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 07/10/2025.