Tigel 90 Tablet

✔️ Pharmacology (Mechanism of Action):

Ticagrelor is a selective ADP (adenosine diphosphate) receptor blocker that acts on the P2Y12 receptor. By reversibly binding to this receptor on platelets, it inhibits ADP-induced platelet activation and aggregation. Although it does not bind directly to the ADP site, it prevents signal transmission, thereby reducing clot formation.

✔️ Side Effects of

• Shortness of breath (dyspnea)
• Bleeding tendency
• Headache, dizziness
• Nausea, diarrhea
• Cough
• Irregular heartbeat (atrial fibrillation)
• Chest discomfort, fatigue, low or high blood pressure

✔️ Dosage & Administration: Tigel 90

• Start with a loading dose of 180 mg (two 90 mg tablets).
• Continue with 90 mg twice daily.
• It should be taken along with aspirin, unless contraindicated:
  • Initial aspirin dose: 325 mg
  • Maintenance dose: 75–100 mg daily
  • Avoid aspirin doses above 100 mg, as it may reduce ticagrelor’s effectiveness.

Missed Dose:
If a dose is missed, take the next scheduled dose (90 mg) without doubling.

Switching Therapy:

• Patients can be switched directly from clopidogrel to ticagrelor.
• Switching from prasugrel has not been well studied.

Duration:
Treatment is generally continued for up to 12 months, unless stopped earlier for clinical reasons.
Can be taken with or without food.

✔️ Interaction

• Avoid strong CYP3A inhibitors: ketoconazole, itraconazole, voriconazole, clarithromycin, ritonavir, etc.
• Avoid strong CYP3A inducers: rifampicin, dexamethasone, phenytoin, carbamazepine, phenobarbital.
• Aspirin (>100 mg/day): reduces ticagrelor effectiveness.
• Simvastatin/Lovastatin: increased levels—avoid doses above 40 mg.
• Digoxin: monitor levels due to P-glycoprotein interaction.

Can be used with:
heparin, GPIIb/IIIa inhibitors, PPIs, beta-blockers, ACE inhibitors, and ARBs.

✔️ Contraindications:

• Allergy to ticagrelor or its components
• Active pathological bleeding (e.g., peptic ulcer)
• History of intracranial hemorrhage
• Moderate to severe liver impairment
• Concomitant use with strong CYP3A4 inhibitors

✔️ Pregnancy & Lactation:

• Pregnancy: Category C; not recommended due to limited safety data.
• Breastfeeding: May pass into breast milk; decision needed whether to stop drug or breastfeeding.

✔️ Precautions & Warnings:

• Increases the risk of bleeding due to platelet inhibition
• Avoid high-dose aspirin (>100 mg daily)
• Not well studied in severe liver disease
• Abrupt discontinuation may increase the risk of heart attack, stent thrombosis, or death

✔️ Storage:

Store below 25°C, protected from light and moisture. Keep out of reach of children.