Tildex 60, 1 Strip

✔️ Dosage & Administration

Patients taking Ticagrelor should generally continue low-dose ASA therapy (75–150 mg daily), unless contraindicated.

Acute Coronary Syndrome (ACS)

• Treatment is initiated with a loading dose of 180 mg (two 90 mg tablets).
• Thereafter, the recommended dose is 90 mg twice daily.
• Therapy is usually continued for 12 months unless discontinuation is medically necessary.

History of Myocardial Infarction

• For extended prevention, the recommended dose is 60 mg twice daily.
• Treatment may continue after completion of the first year of antiplatelet therapy or may be started within 2 years after MI, or within 1 year after stopping previous ADP receptor inhibitor treatment.
• Clinical evidence beyond 3 years of treatment remains limited.

Switching from Other Antiplatelets

• The first dose of ticagrelor should be taken 24 hours after the last dose of the previous antiplatelet medicine.

Missed Dose

• If a dose is missed, the patient should skip the forgotten dose and take the next scheduled dose at the regular time. Double dosing is not recommended.

Special Populations

• Elderly: No dose adjustment required.
• Renal Impairment: No dose adjustment is needed, but use is not recommended in dialysis patients.
• Hepatic Impairment: Contraindicated in severe hepatic impairment; use cautiously in moderate impairment.
• Children: Safety and efficacy in patients below 18 years are not established.
• Ticagrelor may be taken with or without food.

✔️ Effects of Other Medicines on Tildex

• Strong CYP3A4 inhibitors such as clarithromycin, ritonavir, nefazodone, and atazanavir can significantly increase ticagrelor levels and are contraindicated.
• Potent CYP3A inducers like rifampicin may reduce ticagrelor effectiveness and should generally be avoided.
• Caution is advised when used with moderate CYP3A4 or P-gp inhibitors such as verapamil or quinidine.

✔️ Side Effects

Very Common

• Bleeding-related disorders
• Elevated uric acid levels
• Shortness of breath (dyspnoea)

Common

• Headache, dizziness, fainting, vertigo
• Low blood pressure
• Gastrointestinal bleeding, indigestion, nausea, diarrhea, constipation
• Skin rash, itching, bruising, or bleeding under the skin
• Increased creatinine levels
• Bleeding after procedures or trauma

Uncommon

• Allergic reactions, including angioedema
• Confusion
• Intracranial, eye, ear, retroperitoneal, or muscular bleeding

✔️ Effects of Tildex on Other Medicines

• Ticagrelor may increase exposure to medicines metabolized by CYP3A4, including simvastatin and lovastatin; doses above 40 mg are not recommended.
• It may increase levels of atorvastatin slightly, though usually not clinically significant.
• Use caution with medicines having a narrow therapeutic index, including digoxin and cyclosporine.
• Ticagrelor does not significantly affect CYP2C9 substrates such as warfarin or tolbutamide.
• Combined use with SSRIs may raise bleeding risk.
• Care is advised when used with anticoagulants, heparin, enoxaparin, or desmopressin due to additive effects on bleeding.

✔️ Precautions & Warnings

Bleeding Risk

Use carefully in patients with an increased tendency to bleed, including those with recent surgery, trauma, clotting disorders, or gastrointestinal bleeding.

Surgery

Patients should inform healthcare professionals and dentists before undergoing surgery or starting new medications. Ticagrelor should generally be stopped 5 days before elective surgery.

Patients with Prior Stroke

Patients with a history of ischemic stroke may continue therapy for up to 12 months following ACS.

Bradycardia Risk

Use cautiously in individuals prone to slow heart rate or conduction abnormalities.

Respiratory Conditions

Patients with asthma or COPD may have a greater chance of developing dyspnoea during therapy.

Kidney Function & Uric Acid

Ticagrelor may increase serum creatinine and uric acid levels. Renal function should be monitored, especially in elderly patients or those with renal impairment. Caution is advised in patients with gout or hyperuricaemia.

ASA Dose Limitation

High maintenance doses of ASA above 300 mg daily are not recommended when using Tildex.

Premature Discontinuation

Stopping antiplatelet therapy early may increase the risk of cardiovascular death or recurrent myocardial infarction.

✔️ Pregnancy & Lactation

Ticagrelor is generally not recommended during pregnancy. Animal studies suggest that the drug and its metabolites may pass into breast milk. The decision to continue breastfeeding or discontinue therapy should be based on the clinical importance of treatment for the mother and the benefits of breastfeeding for the infant.

✔️ Tildex should not be used in patients with:

• Hypersensitivity to ticagrelor or any component of the formulation
• Active pathological bleeding
• History of intracranial hemorrhage
• Severe liver impairment

✔️ Storage Conditions

Store in a cool, dry place away from light and moisture. Keep out of reach of children.