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Apo-Ticlopidine, Dom-Ticlopidine, Gen-Ticlopidine, Novo-Ticlopidine, NU-Ticlopidine, PMS-Ticlopidine, Sandoz Ticlopidine, Ticlid
Pharmacologic class: Platelet aggregation inhibitor
Therapeutic class: Antiplatelet agent
Pregnancy risk category B
FDA Box Warning
Drug may cause life-threatening hematologic adverse reactions, including neutropenia, agranulocytosis, thrombotic thrombocytopenic purpura (TTP), and aplastic anemia. Such reactions may arise within several days of starting therapy. TTP incidence peaks after about 3 to 4 weeks; neutropenia, at approximately 4 to 6 weeks; and aplastic anemia, after about 4 to 8 weeks. Thereafter, incidence of hematologic reactions declines.
During first 3 months of therapy, monitor patient hematologically and clinically for evidence of neutropenia or TTP. If it occurs, discontinue drug immediately.
Inhibits release of first and second phases of adenosine diphosphate-induced effects on platelet aggregation, preventing thrombus formation
Tablets: 250 mg
⊘Indications and dosages
➣ To reduce risk of thrombotic cerebrovascular accident when aspirin is ineffective or intolerable
Adults: 250 mg P.O. b.i.d. with meals
➣ Adjunctive therapy to prevent subacute stent thrombosis in patients with implanted coronary stents
Adults: 250 mg P.O. b.i.d. with meals, given with antiplatelet doses of aspirin for up to 30 days after successful stent implantation
• Renal impairment
• Chronic arterial occlusion
• Coronary artery bypass graft
• Open-heart surgery
• Intermittent claudication
• Primary glomerulonephritis
• Sickle cell disease
• Subarachnoid hemorrhage
• Uremic patients with atrioventricular shunts or fistulas
• Hypersensitivity to drug
• Hematopoietic disorders
• Hemostatic disorders or active bleeding
• Severe hepatic disease
• History of thrombotic thrombocytopenia purpura (TTP) or aplastic anemia
Use cautiously in:
• renal or hepatic impairment
• high risk for bleeding
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 18 (safety not established).
• Give with meals.
• Don't give within 2 hours of antacids.
CNS: dizziness, headache, weakness, intracerebral bleeding
EENT: conjunctival hemorrhage, tinnitus, epistaxis
GI: nausea, vomiting, diarrhea, full sensation, GI pain, dyspepsia, flatulence, anorexia, GI bleeding
Hematologic: ecchymosis, eosinophilia, purpura, TTP, thrombocytosis, neutropenia, agranulocytosis, bone marrow depression
Skin: rashes, bruising, pruritus, urticaria
Other: pain, posttraumatic or perioperative bleeding
Drug-drug. Antacids: decreased ticlopidine blood level
Aspirin: potentiation of aspirin's effect on platelets
Cimetidine (long-term use): reduced ticlopidine clearance
Digoxin: slightly decreased digoxin blood level
Phenytoin: increased phenytoin blood level, greater risk of toxicity
Theophylline: decreased theophylline clearance, greater risk of toxicity
Vitamin A: altered anticoagulant effects
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase: increased levels
Granulocytes, neutrophils, platelets, white blood cells: decreased counts
Liver function tests: abnormal results
Drug-food. Any food: increased ticlopidine absorption
Drug-herbs. Alfalfa, anise, arnica, astragalus, bilberry, black current seed oil, bladderwrack, bogbean, boldo, borage oil, buchu, capsacin, cat's claw, celery, chapparal, cinchona bark, clove oil, coenzyme Q10, dandelion, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, gingko, guggal, papaya extract, red clover, rhubarb, safflower oil, skullcap, St. John's wort, tan shen: altered anticoagulant effects
Closely monitor coagulation studies and CBC with white cell differential. Watch for evidence of bleeding tendency and blood dyscrasias.
Assess neurologic status carefully. Stay alert for signs and symptoms of intracranial bleeding.
• Monitor liver function tests.
• Tell patient to take with meals, but not within 2 hours of antacids.
Instruct patient to immediately report easy bruising or bleeding.
• Advise patient to stop taking drug 10 to 14 days before elective surgery.
• Tell patient to inform all prescribers that he is taking drug.
• Inform patient that aspirin-containing products and many herbs increase risk of bleeding. Urge him to consult prescriber before taking over-the-counter drugs or herbs.
• Caution patient to avoid activities that can cause injury. Tell him to use soft toothbrush and electric razor to avoid gum and skin injury.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.
ClassificationTherapeutic: antiplatelet agents
Pharmacologic: platelet aggregation inhibitors
Time/action profile (effect on platelet function)
|PO||within 4 days||8–11 days||2 wk|
Adverse Reactions/Side Effects
Central nervous system
Ear, Eye, Nose, Throat
- diarrhea (most frequent)
- GI pain
- ↑ liver enzymes
- rash (most frequent)
- agranulocytosis (life-threatening)
- aplastic anemia (life-threatening)
- intracerebral bleeding (life-threatening)
- neutropenia (life-threatening)
Drug-Drug interactionAspirin potentiates the effect of ticlopidine on platelets (concurrent use not recommended).↑ risk of bleeding with heparins, warfarin, tirofiban, eptifibatide, or thrombolytic agents.Cimetidine ↓ metabolism of ticlopidine and may ↑ the risk of toxicity.Ticlopidine ↓ metabolism and ↑ the risk of toxicity of theophylline.Absorption ↑ by taking with food.
Availability (generic available)
- Assess patient for symptoms of stroke periodically throughout therapy.
- Lab Test Considerations: Monitor bleeding time throughout therapy. Prolonged bleeding time (2–5 times the normal limit), which is time- and dose-dependent, is expected.
- Monitor CBC with differential and platelet count every 2 wk from the 2nd wk to the end of the 3rd mo of therapy; more frequently if absolute neutrophil count (ANC) is declining or <30% of baseline. If neutropenia occurs, ticlopidine should be discontinued. Neutrophil counts usually return to normal within 1–3 wk of discontinuation of therapy. After the first 3 mo of therapy, CBCs need to be obtained only for patients with signs and symptoms of infection.
- May cause thrombocytopenia, usually within 3–12 wk of initiation of therapy. If platelet count is <80,000/mm3, discontinue ticlopidine.
- May cause ↑ serum total cholesterol and triglyceride levels. Levels usually increase 8–10% within the first mo and persist at that level.
Prolonged bleeding time is normalized within 2 hr after administration of IV methylprednisolone. May also use platelet transfusions to reverse effects of ticlopidine on bleeding time.
- May cause ↑ alkaline phosphatase, bilirubin, AST, and ALT levels during the first 4 mo of therapy.
Potential Nursing DiagnosesRisk for injury (Indications, Side Effects)
- Oral: Administer with food or immediately after eating to minimize GI discomfort and increase absorption.
- Instruct patient to take medication as directed. Missed doses should be taken as soon as possible unless almost time for next dose; do not double doses.
- Advise patient to notify health care professional promptly if fever, chills, sore throat, unusual bleeding or bruising, severe or persistent diarrhea, skin rash, jaundice, dark-colored urine, or light-colored stools occur.
- Advise patient to notify health care professional of medication regimen before treatment or surgery. Medication may need to be discontinued 10–14 days before surgery.
- Emphasize the importance of routine lab tests during the first 3 mo of therapy to monitor for side effects.
- Prevention of stroke.