ticlopidine

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trade name: Ticlid; drug class: platelet aggregation inhibitor; action: inhibits first and second phases of adenosine diphosphate (ADP)-induced effects in platelet aggregation; use: effective in reducing the risk of stroke in high-risk patients.

Brand names: Ticlid®

Chemical formula:

Español:
• Tabletas de ticlopidina

Ticlopidine tablets

What are ticlopidine tablets?

TICLOPIDINE (Ticlid®) helps to prevent blood clots. Ticlopidine helps to prevent strokes in patients who have already had a stroke, or those who are at high risk of having a stroke. However, ticlopidine should not used in patients who can take aspirin to prevent a stroke. Ticlopidine is also sometimes used to prevent a heart attack in patients who have already had unstable chest pain or a heart attack. It is also sometimes given with aspirin after certain procedures used to open blocked blood vessels leading to the heart. Generic ticlopidine tablets are available.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of the following conditions:
• anemia
• bleeding disorder currently or history of one (including aplastic anemia, hemophilia, or thrombotic thrombocytopenic purpura [TTP])
• blood disease
• high level of cholesterol
• kidney disease
• liver disease
• recent surgery
• stomach ulcer
• an unusual or allergic reaction to ticlopidine, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I take this medicine?

Take ticlopidine tablets by mouth. Follow the directions on the prescription label. Swallow the tablets with a drink of water. Take with food or milk to help absorb ticlopidine into the body and reduce stomach upset. Avoid antacids for 2 hours before and after the dose of ticlopidine. Take your doses at regular intervals. Do not take your medicine more often than directed.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

What drug(s) may interact with ticlopidine?

• agents that dissolve blood clots
• antacids
• antiinflammatory agents (NSAIDs such as ibuprofen)
• aspirin
• blood thinners such as warfarin
• cimetidine
• cilostazol
• clopidogrel
• cyclosporine
• digoxin
• dipyridamole
• doxercalciferol
• fish oil (omega-3 fatty acids) supplements
• herbal or dietary supplements like feverfew, garlic, ginger, ginkgo biloba, and horse chestnut
• phenytoin
• prasterone, dehydroepiandrosterone, DHEA supplements
• theophylline

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking ticlopidine?

Visit your prescriber or health care professional for regular checks on your progress. Side effects to ticlopidine occur most frequently during the first 3 months of therapy. To make sure you do not develop any problems your health care provider will arrange for you to have blood tests before you start ticlopidine and then every 2 weeks for the first 3 months. It is essential that you keep your appointments for the blood tests. Do not stop taking ticlopidine without your prescriber's advice. If your prescriber decides to stop ticlopidine within the first 3 months, you will still need to have you blood tested for an additional 2 weeks after you have stopped taking ticlopidine.

Ticlopidine can cause serious blood problems. This can mean risk of infection or bleeding. Avoid activities that increase your risk of bleeding. Tell your prescriber or health care professional at once if have any unusual bleeding or bruise easily or an infection that will not get better.

Problems can arise if you need dental work, and in the day to day care of your teeth. Try to avoid damage to your teeth and gums when you brush or floss your teeth. Inform your dentist you are taking ticlopidine prior to any appointment or procedure.

Ask your prescriber or health care professional before you take non-prescription pain relievers. Do not take aspirin, aspirin-containing products, or antiinflammatory drugs such as ibuprofen, ketoprofen, naproxen unless directed to do so by your prescriber or health care professional.

If you are going to have surgery, tell your prescriber or health care professional that you are taking ticlopidine.

What side effects may I notice from taking ticlopidine?

Side effects that you should report to your prescriber or health care professional as soon as possible:
• low blood counts - ticlopidine may decrease the number of white blood cells and/or platelets. You may be at increased risk for infections and bleeding.
• signs of infection - fever or chills, cough, sore throat, pain or difficulty passing urine
• signs of decreased platelets or bleeding - bruising, pinpoint red spots on the skin, black, tarry stools, blood in the urine, nose bleeds, bleeding gums
• dark yellow or brown urine
• difficulty breathing or wheezing
• joint pain or swelling
• paleness
• ringing in the ears
• skin rash or itching (hives)
• stomach pain
• unusually heavy menstrual bleeding
• unusual tiredness or weakness
• weakness on a side of the body
• yellowing of skin or eyes

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• decreased appetite
• diarrhea
• headache
• indigestion
• nausea, vomiting
• stomach pain, bloating, or discomfort

Where can I keep my medicine?

Keep out of the reach of children in a container that small children cannot open.

Store at room temperature between 15—30 degrees C (59—86 degrees F). Throw away any unused medicine after the expiration date.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

An antiplatelet drug used in thrombotic diseases such as heartworm disease in dogs.

Ticlopidine
Systematic (IUPAC) name
3-[(2-chlorophenyl)methyl] -7-thia-3-azabicyclo[4.3.0] nona-8,10-diene
Identifiers
CAS number	55142-85-3
ATC code	B01AC05
PubChem	5472
DrugBank	APRD01257
Chemical data
Formula	C14H14ClNS
Mol. mass	263.786 g/mol
Pharmacokinetic data
Bioavailability	>80%
Protein binding	98%
Metabolism	Hepatic
Half life	12 hours (single dose) 4 to 5 days (after repeated dosing)
Excretion	Renal and fecal
Therapeutic considerations
Pregnancy cat.	B1(AU) C(US)
Legal status
Routes	Oral

Ticlopidine (trade name Ticlid) is an antiplatelet drug in the thienopyridine family. Like clopidogrel, it is an adenosine diphosphate (ADP) receptor inhibitor. It is used in patients in whom aspirin is not tolerated, or in whom dual antiplatelet therapy is desirable. Because it has been reported to increase the risk of thrombotic thrombocytopenic purpura (TTP) and neutropenia, its use has largely been supplanted by the newer drug, clopidogrel, which is felt to have a much lower hematologic risk. The usual dose is 250mg twice daily by the oral route.

Action

• Inihibits platelet aggregation by altering the function of platelet membranes.
• Prolongs bleeding time.
• Decreased incidence of stroke in high-risk patients.

Contraindications

• Hypersensitivity
• Bleeding disorders
• Active bleeding
• Severe liver disease

Precautions

• Risk of bleeding (trauma, surgery, history of peptic ulcer disease)
• Renal or hepatic impairment
• Geriatric patients (increased sensitivity)
• Pregnancy, lactation, or children under 18

Adverse Reactions and Side Effects

• Central Nervous System: anxiety, drowsiness, fatigue, insomnia, nervousness, syncope, vertigo, weakness.
• Ear, Eye, Nose, Throat: cataracts, conjunctivitis, glaucoma, pharyngitis, rhinitis, sinusitis.
• Respiratory: bronchitis.
• Cardiovascular: chest pain, dependent edema, hypertension, peripheral edema.
• Gastrointestinal: abdominal pain, anorexia, constipation, diarrhea, dry mouth, dysphagia, esophageal ulcer, esophagitis, flatulence, gastric ulcer, gastritis, nausea, vomiting.
• Genitourinary: urinary tract infection.
• Dermatologic: flushing, sweating, pruritus, rash (including Stevens-Johnson syndrome), skin disorders.
• Endocrine: hyperparathyroidism.
• Fluid and Electrolyte: hypocalcemia.
• Musculoskeletal: arthrosis, myositis, abnormal muscle contractions, pathological fractures.
• Neurological: paresthesia.
• Miscellaneous: infection.

Route and Dosage

• Adults: 400 mg/day taken with 8oz of plain water only, for 3 months.

Antithrombotics (thrombolytics, anticoagulants and antiplatelet drugs) (B01)
Vitamin K antagonists	Acenocoumarol • Clorindione • Coumatetralyl • Dicumarol (Dicoumarol) • Diphenadione • Ethyl biscoumacetate • Phenprocoumon • Phenindione • Tioclomarol • Warfarin
Heparin group	Antithrombin III • Danaparoid • Heparin • Sulodexide • low molecular weight heparin (Bemiparin, Dalteparin, Enoxaparin, Nadroparin, Parnaparin, Reviparin, Tinzaparin)
Glycoprotein IIb/IIIa inhibitors	Abciximab • Eptifibatide • Tirofiban
Other platelet aggregation inhibitors	Acetylsalicylic acid/Aspirin • Aloxiprin • Ditazole • Carbasalate calcium • Cloricromen • Clopidogrel • Dipyridamole • Indobufen • Picotamide • Prasugrel • Ticlopidine • Triflusal • prostaglandin analogue (Beraprost, Prostacyclin, Iloprost, Treprostinil)
Enzymes	plasminogen activators (Alteplase/Reteplase/Tenecteplase, Streptokinase, Urokinase/Saruplase, Anistreplase) • other serine endopeptidases (Ancrod, Drotrecogin alfa/Protein C, Fibrinolysin) • Brinase
Direct thrombin inhibitors	Argatroban • Bivalirudin • Dabigatran • Desirudin • Hirudin • Lepirudin • Melagatran • Ximelagatran
Other antithrombotics	Defibrotide • Dermatan sulfate • Fondaparinux • Rivaroxaban
Non-medicinal	Citrate • EDTA • Oxalate

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