Ticagrelor

In New Zealand ticagrelor is available as tablets (90 mg).

• The usual dose of ticagrelor is 90 mg (1 tablet) two times a day. You may be given a starting dose of 2 tablets the first time you take it.
• Ticagrelor is usually taken together with low-dose aspirin for up to 12 months.
• Always take your ticagrelor exactly as your doctor has told you. The pharmacy label will tell you how much ticagrelor to take, how often to take it and any special instructions.  

• Timing: Take your ticagrelor doses at the same times each day, in the morning and the evening. You can take ticagrelor with or without food.
• Swallow your tablets with a glass of water. If you have problems swallowing the tablet, you can crush it and mix it with half a glass of water, just before taking it. To make sure that there is no medicine left, rinse the empty glass with another half a glass of water and drink it.
• Missed dose: If you forget to take your dose, take it as soon as you remember that day. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.
• Tell your healthcare provider: It is important to let anyone who gives you treatment know that you are taking ticagrelor, including your dentist, pharmacist, podiatrist and nurse. You may need to stop using this medicine for several days before having surgery, dental appointments or medical tests. 

Like all medicines, ticagrelor can cause side effects, although not everyone gets them. Common side effects include nausea (feeling sick), shortness of breath, feeling dizzy or light headed and diarrhoea (runny poos). These usually go away with time. Tell your doctor if troublesome.

Increased risk of gout

Ticagrelor can increase the level of uric acid in your blood and cause a flare up of gout. Tell your doctor if you get severe pain and swelling in your joints – these are signs of gout.

Increased risk of bleeding

Ticagrelor increases your risk of bleeding. You might bleed or bruise more easily while you are taking ticagrelor. Minor bleeding such as a nosebleed should usually stop on its own. If you have a fall or hurt your head or body, get medical attention immediately, even if you feel okay.

Signs of severe bleeding

If you have any of the following signs of bleeding, contact your doctor immediately or ring Healthline for free 24-hour health advice 0800 611 116:

• becoming pale, very weak and tired, or short of breath
• any bleeding from your gums or cuts or nosebleeds that won’t stop
• blood in your stools (poo) – black, tarry stools
• blood in your urine (wee) – pink, red or brown-coloured urine
• coughing up blood or vomit that looks like coffee grounds
• sudden numbness or weakness of your arm, leg or face, especially if only on one side of your body
• sudden confusion, difficulty speaking or understanding others
• sudden difficulty in walking or loss of balance or co-ordination
• suddenly feeling dizzy or sudden severe headache with no known cause. 

Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product(external link)

Ticagrelor should not be taken with some other medications and herbal supplements, so always check with your doctor or pharmacist before starting ticagrelor or before starting any new medicines. Also check with your pharmacist before taking:

• over-the-counter anti-inflammatories such as diclofenac (eg, Voltaren Rapid), ibuprofen (eg, Nurofen), naproxen (eg, Naprogesic)
• herbal extracts such as garlic, ginkgo or ginseng.

Taking these together with ticagrelor may increase your risk of bleeding and should be avoided.