Overview
The combined use of ticagrelor, levonorgestrel and ethinyl estradiol increases the exposure of ethinyl estradiol by about 20%, but does not affect the pharmacokinetics of levonorgestrel. No Brilinta significant effect on contraceptive effectiveness is expected with the simultaneous use of levonorgestrel, ethinyl estradiol and ticagrelor.
Medicines that can cause bradycardia
In connection with the identification of mainly asymptomatic ventricular pauses and bradycardia, you should be careful to take the drug Brilinta simultaneously with drugs that can cause bradycardia. However, in the PLATO study, there were no clinically significant adverse events when combined with one or more drugs that could cause bradycardia (for example, 96% of patients took beta-blockers at the same time, 33% slow calcium channel blockers, diltiazem and verapamil, and 4% - digoxin).
Other concomitant therapy
In clinical studies, the Brilinta drug was mainly prescribed in conjunction with ASA, about pump inhibitors, statins, beta-blockers, ACE inhibitors and angiotensin II receptor antagonists as part of a long-term administration for the treatment of concomitant diseases, as well as with heparin, low molecular weight heparins, II glycoprotein II inhibitors receptors for iv administration as part of short-term therapy. Based on the results of these studies, no clinically significant adverse interaction was detected.
The combined use of the Brilint drug with heparin, enoxaparin, or desmopressin did not affect APTT, activated clotting time (ABC), and factor Xa studies; however, due to potential pharmacodynamic interaction, caution should be exercised when combined with drugs that affect hemostasis.
In connection with reports of subcutaneous hemorrhage associated with the use of selective serotonin reuptake inhibitors (e.g., paroxetine, sertraline and citalopram), caution is advised when taken with ticagrelor, since there may be an increased risk of bleeding.
special instructions
Risk of bleeding
When prescribing the drug Brilint, patients with an increased risk of bleeding should assess the ratio of the benefits of preventing atherothrombotic complications and the risk of bleeding.
allow the presence of clinical indications, the Brilint drug should be used with caution in the following situations:
- predisposition of patients to the development of bleeding (for example, in connection with a recent injury, a recent operation, bleeding disorders, impaired liver function of moderate severity, active or recent bleeding from the digestive tract). The use of the drug Brilint is contraindicated in patients with active pathological bleeding, a history of intracranial hemorrhage, severe liver dysfunction;
- concomitant use of drugs that can increase the risk of bleeding (for example, NSAIDs, oral anticoagulants and / or fibrinolytics taken within 24 hours before taking Brilinta drug).
There is no evidence of hemostatic efficacy of platelet transfusions in patients with ticagrelor; circulating ticagrelor may inhibit transfused platelets in Brilinta blood. Because with the concomitant use of Brilint's drug and desmopressin, the standardized bleeding time did not decrease, it is unlikely that desmopressin https://zentherapycenter.com/let-k/ketopine-2.php effectively stop clinically significant bleeding.
Antifibrinolytic therapy (aminocaproic acid or tranexamic acid) and / or therapy with recombinant factor Vlla can increase hemostasis. After establishing the cause of bleeding and stopping it, therapy with ticagrelor can be resumed.
Before the planned operation or the start of taking new drugs, the patient should inform the doctor about taking the drug Brilint.
In the PLATO study in patients undergoing CABG, when using the Brilint drug, there was more bleeding compared with clopidogrel when therapy was stopped 1 day before surgery, but the incidence of major bleeding after discontinuation of therapy 2 or more days before surgery was similar in comparison with clopidogrel. If the patient undergoes a planned operation and an antithrombotic effect is not desired, then Brilint therapy should be discontinued 7 days before surgery.
Patients with Prior Ischemic Stroke
Patients with ACS with a previous ischemic stroke can take Brilinta for up to 12 months (PLATO study).
The PEGASUS study did not include patients with a history of myocardial infarction with a previous ischemic stroke. Therefore, in the absence of data, care should be taken with a duration of more than 1 year.