ticlopidine, Ticlid (discontinued brand in the US)

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GENERIC NAME: ticlopidine

BRAND NAME: Ticlid (Discontinued brand in the US)

DRUG CLASS AND MECHANISM: Ticlopidine is an oral drug that inhibits the ability of platelets to clump and form blood clots. It prevents blood clots by binding to the P2Y12 receptor on platelets, preventing adenosine diphosphate (ADP) from activating platelets. It belongs to a class of drugs called P2Y12 inhibitors. Other drugs in this class include clopidogrel (Plavix), ticagrelor (Brilinta) and prasugrel (Effient). Clopidogrel is similar to ticlopidine (Ticlid) in chemical structure and in the way it works. Blood clots that form within the arteries of the brain or pieces of blood clots that break off from clots in other parts of the body and lodge in blood vessels in the brain cause strokes. Similarly, heart attacks occur when blood clots block an artery in the heart. In both cases the blood supply to part of the brain or heart is blocked, and that part of the brain or heart is damaged or dies. Ticlopidine works by making the blood less likely to clot, therefore, reducing the likelihood of a stroke or heart attack. The FDA approved ticlopidine in October 1991.



PREPARATIONS: Tablets: 250 mg

STORAGE: Ticlopidine should be stored at room temperature, 15 to 30 C (59 to 86 F).

PRESCRIBED FOR: Ticlopidine is used for preventing strokes in patients who have a history of stroke or transient ischemic attacks (TIAs or "mini-stroke"). It also is used for preventing blood clots in stents placed in the arteries of the heart. Non-FDA approved (off-label) uses include prevention of heart attacks in patients with unstable angina (that often precedes heart attacks) or who have experienced prior heart attacks; in combination with aspirin for preventing blood clots in stents; and for intermittent claudication (due to blockage by clots of blood flowing to the legs). Ticlopidine is most often used when aspirin has failed, is not tolerated, or cannot be used for other reasons. It is rarely used otherwise because of a serious side effect that can reduce white blood cells and platelets.

DOSING: The recommended dose is 250 mg twice daily with food for stroke prevention. For preventing blood clots in stents, a single 500 mg loading dose is administered several hours before stent placement, and then 250 mg is administered twice daily for 10-14 days after successful stent placement.

DRUG INTERACTIONS: Combining ticlopidine with other drugs that promote bleeding increases the risk of bleeding. Examples include aspirin, warfarin (Coumadin), and heparin. Ticlopidine may increase duloxetine (Cymbalta) levels by reducing the break down of duloxetine in the liver and thereby lead to side effects from duloxetine. The combination may also increase the risk of bleeding because duloxetine can interfere with platelet function. Ticlopidine may increase pimozide (Orap) levels by reducing the break-down of pimozide in the liver. Increased pimozide levels may cause abnormal heart rhythms.

PREGNANCY: Ticlopidine has not been adequately studied in pregnant women.

NURSING MOTHERS: It is not known if ticlopidine is secreted in human breast milk.

SIDE EFFECTS: Common side effects of ticlopidine include diarrhea, nausea, rash, stomach upset, and vomiting. Ticlopidine has been associated with a severe reduction in white blood cell count. Ticlopidine also causes a condition called thrombotic thrombocytopenic purpura (TTP). TTP is a serious condition in which blood clots form throughout the body. Blood platelets, which participate in clotting, are consumed, and the result can be bleeding because enough platelets are no longer left to allow blood to clot normally.

Reference: FDA Prescribing Information

Last Editorial Review: 8/2/2012

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