ticlopidine, Ticlid (discontinued brand in the US) (cont.)

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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.

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