Brilinta

Overview

ticagrelor

antiplatelet

• CYP3A4 substrate
• P-gp substrate
• CYP3A4 inhibitor, weak
• BCRP inhibitor
• ENT1 inhibitor
• P-gp inhibitor, weak
• affected by altered gastrointestinal motility
• antiplatelet
• bradycardia
• delays atrioventricular conduction

Contraindicated

• abrocitinib
Brilinta (ticagrelor)

+

abrocitinib

1 interaction

Contraindicated

ticagrelor + abrocitinib

contraindicated: combo may incr. risk of bleeding, including life-threatening (additive effects)

• cisapride
Brilinta (ticagrelor)

+

cisapride

1 interaction

Contraindicated

ticagrelor + cisapride

contraindicated: combo may incr. cisapride levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• colchicine
Brilinta (ticagrelor)

+

colchicine

1 interaction

Contraindicated

ticagrelor + colchicine

CV RISK REDUCTION: consider monitoring CK, myopathy s/sx; GOUT OR FMF: contraindicated in pts w/ renal or hepatic impairment; otherwise, use alternative or consider decr. colchicine dose during and x14 days after ticagrelor use: combo may incr. colchicine levels, risk of myopathy, rhabdomyolysis, other life-threatening toxicity (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• eliglustat
Brilinta (ticagrelor)

+

eliglustat

1 interaction

Contraindicated

ticagrelor + eliglustat

CYP2D6 EM: contraindicated if Child-Pugh Class A and if also combined w/ moderate or strong CYP2D6 inhibitor; if also combined w/ moderate or strong CYP2D6 inhibitor, monitor ECG, HR and decr. eliglustat dose to 84 mg qd; otherwise, monitor ECG, HR; CYP2D6 IM: if also combined w/ moderate or strong CYP2D6 inhibitor, monitor ECG, HR and decr. eliglustat dose to 84 mg qd; otherwise, monitor ECG, HR; CYP2D6 PM: avoid combo: combo may incr. eliglustat levels, risk of PR or QT prolongation, cardiac arrhythmias, AV block, bradycardia, other adverse effects (hepatic metabolism inhibited, additive effects)

• itraconazole
Brilinta (ticagrelor)

+

itraconazole

1 interaction

Contraindicated

ticagrelor + itraconazole

contraindicated during and x2wk after itraconazole tx: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

Avoid/Use Alternative

• adagrasib
Brilinta (ticagrelor)

+

adagrasib

1 interaction

Avoid/Use Alternative

ticagrelor + adagrasib

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• alfentanil
Brilinta (ticagrelor)

+

alfentanil

1 interaction

Avoid/Use Alternative

ticagrelor + alfentanil

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, monitor respiratory rate, HR, consider decr. alfentanil dose: combo may decr. ticagrelor and active metabolite levels, efficacy; may incr. alfentanil levels, risk of CNS and respiratory depression, delayed recovery from anesthesia, bradycardia, other adverse effects (absorption of ticagrelor possibly affected by delayed gastric emptying; hepatic metabolism inhibited, additive effects)

• alpelisib
Brilinta (ticagrelor)

+

alpelisib

1 interaction

Avoid/Use Alternative

ticagrelor + alpelisib

use alternative: combo may incr. alpelisib levels, risk of adverse effects (BCRP-mediated transport possibly inhibited)

• alprazolam
Brilinta (ticagrelor)

+

alprazolam

1 interaction

Avoid/Use Alternative

ticagrelor + alprazolam

use alternative or monitor respiratory rate; consider decr. alprazolam dose: combo may incr. alprazolam levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• apalutamide
Brilinta (ticagrelor)

+

apalutamide

1 interaction

Avoid/Use Alternative

ticagrelor + apalutamide

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced, P-gp-mediated transport induced)

• apixaban
Brilinta (ticagrelor)

+

apixaban

1 interaction

Avoid/Use Alternative

ticagrelor + apixaban

ADULT PTS: monitor bleeding s/sx; if also combined w/ strong CYP3A4 inhibitor, decr. apixaban 5mg bid or 10 mg bid dose by 50% or avoid combo if already on 2.5 mg bid; PEDS PTS: monitor bleeding s/sx; if also combined w/ strong CYP3A4 inhibitor, consider decr. apixaban dose: combo may incr. apixaban levels, risk of bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• atazanavir
Brilinta (ticagrelor)

+

atazanavir

1 interaction

Avoid/Use Alternative

ticagrelor + atazanavir

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, PR interval prolongation, AV block, bradycardia, other adverse effects (hepatic metabolism inhibited, additive effects)

• bosentan
Brilinta (ticagrelor)

+

bosentan

1 interaction

Avoid/Use Alternative

ticagrelor + bosentan

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• brigatinib
Brilinta (ticagrelor)

+

brigatinib

1 interaction

Avoid/Use Alternative

ticagrelor + brigatinib

use alternative or monitor BP, HR: combo may incr. brigatinib levels, risk of HTN, bradycardia, other adverse effects; may decr. ticagrelor levels, efficacy (hepatic metabolism inhibited, additive effects; hepatic metabolism induced)

• buprenorphine
Brilinta (ticagrelor)

+

buprenorphine

1 interaction

Avoid/Use Alternative

ticagrelor + buprenorphine

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• butalbital
Brilinta (ticagrelor)

+

butalbital

1 interaction

Avoid/Use Alternative

ticagrelor + butalbital

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• butorphanol
Brilinta (ticagrelor)

+

butorphanol

1 interaction

Avoid/Use Alternative

ticagrelor + butorphanol

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• caplacizumab
Brilinta (ticagrelor)

+

caplacizumab

1 interaction

Avoid/Use Alternative

ticagrelor + caplacizumab

use alternative or monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• carbamazepine
Brilinta (ticagrelor)

+

carbamazepine

1 interaction

Avoid/Use Alternative

ticagrelor + carbamazepine

avoid combo: combo may decr. ticagrelor levels, efficacy; may incr. carbamazepine levels, risk of adverse effects; may incr. risk of PR interval prolongation, AV block, bradycardia (hepatic metabolism induced, P-gp-mediated transport induced; hepatic metabolism inhibited; additive effects)

• cenobamate
Brilinta (ticagrelor)

+

cenobamate

1 interaction

Avoid/Use Alternative

ticagrelor + cenobamate

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• ceritinib
Brilinta (ticagrelor)

+

ceritinib

1 interaction

Avoid/Use Alternative

ticagrelor + ceritinib

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, bradycardia, other adverse effects (hepatic metabolism inhibited, additive effects)

• chloramphenicol
Brilinta (ticagrelor)

+

chloramphenicol

1 interaction

Avoid/Use Alternative

ticagrelor + chloramphenicol

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• cladribine oral
Brilinta (ticagrelor)

+

cladribine oral

1 interaction

Avoid/Use Alternative

ticagrelor + cladribine oral

use alternative or monitor CBC: combo may incr. cladribine levels, risk of serious infection, myelosuppression, other adverse effects; may alter cladribine intracellular distribution and renal elimination, clinical impact unknown (gut BCRP-mediated transport inhibited; ENT1-mediated transport inhibited)

• clarithromycin
Brilinta (ticagrelor)

+

clarithromycin

1 interaction

Avoid/Use Alternative

ticagrelor + clarithromycin

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• clonidine
Brilinta (ticagrelor)

+

clonidine

1 interaction

Avoid/Use Alternative

ticagrelor + clonidine

if ADHD use, avoid combo; otherwise, monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• cobicistat
Brilinta (ticagrelor)

+

cobicistat

1 interaction

Avoid/Use Alternative

ticagrelor + cobicistat

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• codeine
Brilinta (ticagrelor)

+

codeine

1 interaction

Avoid/Use Alternative

ticagrelor + codeine

use alternative or monitor respiratory rate, consider decr. codeine dose; consider alternative parenteral antiplatelet agent for acute tx of ACS: combo may incr. codeine and active metabolite morphine levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects; may decr. ticagrelor and active metabolite levels, efficacy (hepatic metabolism inhibited, may incr. production of active metabolite morphine; absorption of ticagrelor possibly affected by delayed gastric emptying)

• collagenase clostridium histolyticum
Brilinta (ticagrelor)

+

collagenase clostridium histolyticum

1 interaction

Avoid/Use Alternative

ticagrelor + collagenase clostridium histolyticum

DUPUYTREN or PEYRONIE: avoid combo w/in 7 days of ticagrelor use; CELLULITE: monitor injection site bleeding s/sx: combo may incr. risk of localized bleeding, including severe (additive effects)

• crizotinib
Brilinta (ticagrelor)

+

crizotinib

1 interaction

Avoid/Use Alternative

ticagrelor + crizotinib

use alternative or monitor HR, BP: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, bradycardia, other adverse effects (hepatic metabolism inhibited, additive effects)

• dabigatran
Brilinta (ticagrelor)

+

dabigatran

1 interaction

Avoid/Use Alternative

ticagrelor + dabigatran

monitor bleeding s/sx; ATRIAL FIBRILLATION: avoid combo if CrCl <30 mL/min; OTHER INDICATIONS: avoid combo if CrCl <50 mL/min; if dabigatran use for DVT/PE prophylaxis post-hip replacement and CrCl >50 mL/min, consider separating admin. at least 2h apart: combo may incr. dabigatran levels, risk of bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• dabrafenib
Brilinta (ticagrelor)

+

dabrafenib

1 interaction

Avoid/Use Alternative

ticagrelor + dabrafenib

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• danshen
Brilinta (ticagrelor)

+

danshen

1 interaction

Avoid/Use Alternative

ticagrelor + danshen

use alternative or monitor bleeding s/sx: combo may decr. ticagrelor levels, efficacy; may incr. risk of bleeding, including life-threatening (hepatic metabolism induced, P-gp-mediated transport induced; additive effects)

• darunavir
Brilinta (ticagrelor)

+

darunavir

1 interaction

Avoid/Use Alternative

ticagrelor + darunavir

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• difenoxin
Brilinta (ticagrelor)

+

difenoxin

1 interaction

Avoid/Use Alternative

ticagrelor + difenoxin

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• dihydrocodeine
Brilinta (ticagrelor)

+

dihydrocodeine

1 interaction

Avoid/Use Alternative

ticagrelor + dihydrocodeine

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• diphenoxylate
Brilinta (ticagrelor)

+

diphenoxylate

1 interaction

Avoid/Use Alternative

ticagrelor + diphenoxylate

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• efavirenz
Brilinta (ticagrelor)

+

efavirenz

1 interaction

Avoid/Use Alternative

ticagrelor + efavirenz

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced, P-gp-mediated transport induced)

• encorafenib
Brilinta (ticagrelor)

+

encorafenib

1 interaction

Avoid/Use Alternative

ticagrelor + encorafenib

avoid combo: combo may incr. encorafenib levels, risk of QT prolongation, cardiac arrhythmias, GI or other bleeding (including life-threatening), other adverse effects; may decr. ticagrelor levels, efficacy (hepatic metabolism inhibited, additive effects; hepatic metabolism induced)

• enoxaparin
Brilinta (ticagrelor)

+

enoxaparin

1 interaction

Avoid/Use Alternative

ticagrelor + enoxaparin

use alternative or monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• ensartinib
Brilinta (ticagrelor)

+

ensartinib

1 interaction

Avoid/Use Alternative

ticagrelor + ensartinib

avoid combo: combo may incr. ensartinib levels, risk of bradycardia, hyperglycemia, other adverse effects (P-gp-mediated transport possibly inhibited, additive effects)

• enzalutamide
Brilinta (ticagrelor)

+

enzalutamide

1 interaction

Avoid/Use Alternative

ticagrelor + enzalutamide

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• etrasimod
Brilinta (ticagrelor)

+

etrasimod

1 interaction

Avoid/Use Alternative

ticagrelor + etrasimod

consider alternative or monitor HR, ECG, especially when starting or restarting etrasimod tx: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• etravirine
Brilinta (ticagrelor)

+

etravirine

1 interaction

Avoid/Use Alternative

ticagrelor + etravirine

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• fentanyl
Brilinta (ticagrelor)

+

fentanyl

1 interaction

Avoid/Use Alternative

ticagrelor + fentanyl

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, monitor respiratory rate, HR, consider decr. fentanyl dose: combo may decr. ticagrelor and active metabolite levels, efficacy; may incr. fentanyl levels, risk of CNS and respiratory depression, psychomotor impairment, bradycardia, other adverse effects (absorption of ticagrelor possibly affected by delayed gastric emptying; hepatic metabolism inhibited, additive effects)

• fexinidazole
Brilinta (ticagrelor)

+

fexinidazole

1 interaction

Avoid/Use Alternative

ticagrelor + fexinidazole

avoid combo during and x7 days after fexinidazole tx; if possible, do not initiate fexinidazole until 5 half-lives after ticagrelor D/C: combo may decr. ticagrelor levels, efficacy; may decr. fexinidazole active metabolite levels, efficacy; may incr. risk of QT prolongation, cardiac arrhythmias (hepatic metabolism induced; hepatic metabolism inhibited, decr. conversion to active metabolites; bradycardia may incr. risk of QT prolongation)

• fingolimod
Brilinta (ticagrelor)

+

fingolimod

1 interaction

Avoid/Use Alternative

ticagrelor + fingolimod

use alternative or monitor HR, ECG overnight, esp. during fingolimod initiation/titration: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• fondaparinux
Brilinta (ticagrelor)

+

fondaparinux

1 interaction

Avoid/Use Alternative

ticagrelor + fondaparinux

use alternative or monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• fosphenytoin
Brilinta (ticagrelor)

+

fosphenytoin

1 interaction

Avoid/Use Alternative

ticagrelor + fosphenytoin

avoid combo: combo may decr. ticagrelor levels, efficacy; may incr. risk of PR interval prolongation, AV block, bradycardia (hepatic metabolism induced, P-gp-mediated transport induced; additive effects)

• hydrocodone
Brilinta (ticagrelor)

+

hydrocodone

1 interaction

Avoid/Use Alternative

ticagrelor + hydrocodone

use alternative or monitor respiratory rate, ECG, consider decr. (benz)hydrocodone dose; consider alternative parenteral antiplatelet agent for acute tx of ACS: combo may incr. hydrocodone levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. ticagrelor and active metabolite levels, efficacy (hepatic metabolism inhibited; absorption of ticagrelor possibly affected by delayed gastric emptying)

• hydromorphone
Brilinta (ticagrelor)

+

hydromorphone

1 interaction

Avoid/Use Alternative

ticagrelor + hydromorphone

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• ibritumomab tiuxetan
Brilinta (ticagrelor)

+

ibritumomab tiuxetan

1 interaction

Avoid/Use Alternative

ticagrelor + ibritumomab tiuxetan

use alternative or monitor platelets, bleeding s/sx: combo may incr. risk of severe bleeding, including life-threatening (additive effects)

• idelalisib
Brilinta (ticagrelor)

+

idelalisib

1 interaction

Avoid/Use Alternative

ticagrelor + idelalisib

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• ivosidenib
Brilinta (ticagrelor)

+

ivosidenib

1 interaction

Avoid/Use Alternative

ticagrelor + ivosidenib

avoid combo: combo may incr. ivosidenib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may decr. ticagrelor levels, efficacy (hepatic metabolism inhibited; hepatic metabolism induced)

• ketoconazole
Brilinta (ticagrelor)

+

ketoconazole

1 interaction

Avoid/Use Alternative

ticagrelor + ketoconazole

avoid combo during and up to 1wk after ketoconazole tx: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• landiolol
Brilinta (ticagrelor)

+

landiolol

1 interaction

Avoid/Use Alternative

ticagrelor + landiolol

avoid combo: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• levoketoconazole
Brilinta (ticagrelor)

+

levoketoconazole

1 interaction

Avoid/Use Alternative

ticagrelor + levoketoconazole

avoid combo x2wk before and during levoketoconazole tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• levorphanol
Brilinta (ticagrelor)

+

levorphanol

1 interaction

Avoid/Use Alternative

ticagrelor + levorphanol

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• lofexidine
Brilinta (ticagrelor)

+

lofexidine

1 interaction

Avoid/Use Alternative

ticagrelor + lofexidine

use alternative or monitor HR: combo may incr. risk of bradycardia (additive effects)

• lonafarnib
Brilinta (ticagrelor)

+

lonafarnib

1 interaction

Avoid/Use Alternative

ticagrelor + lonafarnib

avoid combo: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• loperamide
Brilinta (ticagrelor)

+

loperamide

1 interaction

Avoid/Use Alternative

ticagrelor + loperamide

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• lopinavir/ritonavir
Brilinta (ticagrelor)

+

lopinavir/ ritonavir

1 interaction

Avoid/Use Alternative

ticagrelor + lopinavir/ ritonavir

avoid combo: combo may incr. or decr. ticagrelor levels, incr. risk of dyspnea, bleeding, PR interval prolongation, AV block, bradycardia, other adverse effects or decr. efficacy (hepatic metabolism altered, additive effects)

• lorlatinib
Brilinta (ticagrelor)

+

lorlatinib

1 interaction

Avoid/Use Alternative

ticagrelor + lorlatinib

avoid combo: combo may decr. ticagrelor levels, efficacy; may incr. risk of PR interval prolongation, AV block, bradycardia (hepatic metabolism induced, P-gp-mediated transport induced; additive effects)

• lovastatin
Brilinta (ticagrelor)

+

lovastatin

1 interaction

Avoid/Use Alternative

ticagrelor + lovastatin

avoid lovastatin doses >40 mg/day; otherwise, monitor CK, myopathy sx: combo may incr. lovastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited)

• lumacaftor/ivacaftor
Brilinta (ticagrelor)

+

lumacaftor/ ivacaftor

1 interaction

Avoid/Use Alternative

ticagrelor + lumacaftor/ ivacaftor

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced, P-gp-mediated transport possibly induced)

• mavacamten
Brilinta (ticagrelor)

+

mavacamten

1 interaction

Avoid/Use Alternative

ticagrelor + mavacamten

avoid combo: combo may incr. mavacamten levels, risk of heart failure, other adverse effects; may decr. ticagrelor levels, efficacy (hepatic metabolism inhibited; hepatic metabolism induced)

• meperidine
Brilinta (ticagrelor)

+

meperidine

1 interaction

Avoid/Use Alternative

ticagrelor + meperidine

use alternative or monitor respiratory rate, ECG; consider alternative parenteral antiplatelet agent for acute tx of ACS: combo may incr. meperidine levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. ticagrelor and active metabolite levels, efficacy (hepatic metabolism inhibited; absorption of ticagrelor possibly affected by delayed gastric emptying)

• methadone
Brilinta (ticagrelor)

+

methadone

1 interaction

Avoid/Use Alternative

ticagrelor + methadone

use alternative or monitor respiratory rate, ECG, consider decr. methadone dose; consider alternative parenteral antiplatelet agent for acute tx of ACS: combo may incr. methadone levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. ticagrelor and active metabolite levels, efficacy (hepatic metabolism inhibited; absorption of ticagrelor possibly affected by delayed gastric emptying)

• mifepristone
Brilinta (ticagrelor)

+

mifepristone

1 interaction

Avoid/Use Alternative

ticagrelor + mifepristone

avoid combo w/in 14 days of daily mifepristone use: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• mitapivat
Brilinta (ticagrelor)

+

mitapivat

1 interaction

Avoid/Use Alternative

ticagrelor + mitapivat

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• mitotane
Brilinta (ticagrelor)

+

mitotane

1 interaction

Avoid/Use Alternative

ticagrelor + mitotane

avoid combo: combo may decr. ticagrelor levels, efficacy; may incr. risk of bleeding, including life-threatening (hepatic metabolism induced; additive effects)

• modafinil
Brilinta (ticagrelor)

+

modafinil

1 interaction

Avoid/Use Alternative

ticagrelor + modafinil

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• morphine
Brilinta (ticagrelor)

+

morphine

1 interaction

Avoid/Use Alternative

ticagrelor + morphine

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, monitor respiratory rate, consider decr. dose of one or both drugs: combo may decr. ticagrelor and active metabolite levels, efficacy; may incr. morphine levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (absorption of ticagrelor possibly affected by delayed gastric emptying; P-gp-mediated transport inhibited)

• nafcillin
Brilinta (ticagrelor)

+

nafcillin

1 interaction

Avoid/Use Alternative

ticagrelor + nafcillin

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• nalbuphine
Brilinta (ticagrelor)

+

nalbuphine

1 interaction

Avoid/Use Alternative

ticagrelor + nalbuphine

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• nefazodone
Brilinta (ticagrelor)

+

nefazodone

1 interaction

Avoid/Use Alternative

ticagrelor + nefazodone

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• nelfinavir
Brilinta (ticagrelor)

+

nelfinavir

1 interaction

Avoid/Use Alternative

ticagrelor + nelfinavir

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• neratinib
Brilinta (ticagrelor)

+

neratinib

1 interaction

Avoid/Use Alternative

ticagrelor + neratinib

avoid combo if also combined w/ strong-mod CYP3A4 inhibitor; otherwise, caution advised: combo may incr. neratinib levels, risk of adverse effects (P-gp-mediated transport inhibited)

• oliceridine
Brilinta (ticagrelor)

+

oliceridine

1 interaction

Avoid/Use Alternative

ticagrelor + oliceridine

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, monitor respiratory rate, ECG: combo may incr. oliceridine levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects; may decr. ticagrelor and active metabolite levels, efficacy (hepatic metabolism inhibited; absorption of ticagrelor possibly affected by delayed gastric emptying)

• opium
Brilinta (ticagrelor)

+

opium

1 interaction

Avoid/Use Alternative

ticagrelor + opium

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• oxycodone
Brilinta (ticagrelor)

+

oxycodone

1 interaction

Avoid/Use Alternative

ticagrelor + oxycodone

use alternative or monitor respiratory rate; consider decr. oxycodone dose; consider alternative parenteral antiplatelet agent for acute tx of ACS: combo may incr. oxycodone levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects; may decr. ticagrelor and active metabolite levels, efficacy (hepatic metabolism inhibited; absorption of ticagrelor possibly affected by delayed gastric emptying)

• oxymorphone
Brilinta (ticagrelor)

+

oxymorphone

1 interaction

Avoid/Use Alternative

ticagrelor + oxymorphone

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• ozanimod
Brilinta (ticagrelor)

+

ozanimod

1 interaction

Avoid/Use Alternative

ticagrelor + ozanimod

use alternative or monitor HR, ECG, especially when starting or restarting ozanimod tx: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• pacritinib
Brilinta (ticagrelor)

+

pacritinib

1 interaction

Avoid/Use Alternative

ticagrelor + pacritinib

avoid combo: combo may incr. pacritinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, bleeding (including life-threatening), other adverse effects; may decr. ticagrelor levels, efficacy (hepatic metabolism inhibited, additive effects; hepatic metabolism induced)

• pazopanib
Brilinta (ticagrelor)

+

pazopanib

1 interaction

Avoid/Use Alternative

ticagrelor + pazopanib

avoid combo: combo may incr. pazopanib levels, risk of QT prolongation, cardiac arrhythmias, GI or other bleeding (including life-threatening), other adverse effects (BCRP-mediated transport inhibited, additive effects)

• pentazocine
Brilinta (ticagrelor)

+

pentazocine

1 interaction

Avoid/Use Alternative

ticagrelor + pentazocine

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• pentobarbital
Brilinta (ticagrelor)

+

pentobarbital

1 interaction

Avoid/Use Alternative

ticagrelor + pentobarbital

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• pexidartinib
Brilinta (ticagrelor)

+

pexidartinib

1 interaction

Avoid/Use Alternative

ticagrelor + pexidartinib

avoid combo: combo may decr. ticagrelor levels, efficacy; may incr. pexidartinib levels, risk of hepatotoxicity, other adverse effects (hepatic metabolism induced; hepatic metabolism inhibited)

• phenobarbital
Brilinta (ticagrelor)

+

phenobarbital

1 interaction

Avoid/Use Alternative

ticagrelor + phenobarbital

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced, P-gp-mediated transport possibly induced)

• phenytoin
Brilinta (ticagrelor)

+

phenytoin

1 interaction

Avoid/Use Alternative

ticagrelor + phenytoin

avoid combo: combo may decr. ticagrelor levels, efficacy; may incr. risk of bradycardia (hepatic metabolism induced, P-gp-mediated transport induced; additive effects)

• pimozide
Brilinta (ticagrelor)

+

pimozide

1 interaction

Avoid/Use Alternative

ticagrelor + pimozide

use alternative or monitor ECG: combo may incr. pimozide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• ponesimod
Brilinta (ticagrelor)

+

ponesimod

1 interaction

Avoid/Use Alternative

ticagrelor + ponesimod

use alternative or monitor HR, ECG, especially when starting or restarting ponesimod tx: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• posaconazole
Brilinta (ticagrelor)

+

posaconazole

1 interaction

Avoid/Use Alternative

ticagrelor + posaconazole

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• pralsetinib
Brilinta (ticagrelor)

+

pralsetinib

1 interaction

Avoid/Use Alternative

ticagrelor + pralsetinib

use alternative or monitor bleeding s/sx, consider monitoring ECG, electrolytes and decr. pralsetinib dose as follows: if on pralsetinib 400 mg qd, decr. to 300 mg qd; if on pralsetinib 300 mg qd, decr. to 200 mg qd; if on pralsetinib 200 mg qd, decr. to 100 mg qd: combo may incr. pralsetinib levels, risk of QT prolongation, cardiac arrhythmias, bleeding, including life-threatening, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, additive effects)

• primidone
Brilinta (ticagrelor)

+

primidone

1 interaction

Avoid/Use Alternative

ticagrelor + primidone

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced, P-gp-mediated transport possibly induced)

• propafenone
Brilinta (ticagrelor)

+

propafenone

1 interaction

Avoid/Use Alternative

ticagrelor + propafenone

if CYP2D6 poor metabolizer or if also combined w/ CYP2D6 inhibitor, avoid combo; otherwise, monitor ECG, BP, HR: combo may incr. levels of both drugs, risk of QT and PR interval prolongation, cardiac arrhythmias, AV block, bradycardia, hypotension, dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, additive effects)

• relugolix
Brilinta (ticagrelor)

+

relugolix

1 interaction

Avoid/Use Alternative

ticagrelor + relugolix

PROSTATE CANCER: may hold relugolix if ticagrelor tx up to 2wk; otherwise, use alternative or monitor ECG, electrolytes and admin. relugolix at least 6h before ticagrelor; FIBROID-ASSOC. BLEEDING: use alternative or admin. relugolix at least 6h before ticagrelor: combo may incr. relugolix levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (gut P-gp-mediated transport inhibited)

• remifentanil
Brilinta (ticagrelor)

+

remifentanil

1 interaction

Avoid/Use Alternative

ticagrelor + remifentanil

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, monitor HR: combo may decr. ticagrelor and active metabolite levels, efficacy; may incr. risk of bradycardia (absorption of ticagrelor possibly affected by delayed gastric emptying; additive effects)

• repotrectinib
Brilinta (ticagrelor)

+

repotrectinib

1 interaction

Avoid/Use Alternative

ticagrelor + repotrectinib

avoid combo: combo may incr. repotrectinib levels, risk of adverse effects; may decr. ticagrelor levels, efficacy (hepatic metabolism inhibited, P-gp-mediated transport inhibited; hepatic metabolism induced)

• ribociclib
Brilinta (ticagrelor)

+

ribociclib

1 interaction

Avoid/Use Alternative

ticagrelor + ribociclib

avoid combo: combo may incr. levels of both drugs, risk of dyspnea, bleeding, QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• rifabutin
Brilinta (ticagrelor)

+

rifabutin

1 interaction

Avoid/Use Alternative

ticagrelor + rifabutin

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced, P-gp-mediated transport possibly induced)

• rifampin
Brilinta (ticagrelor)

+

rifampin

1 interaction

Avoid/Use Alternative

ticagrelor + rifampin

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced, P-gp-mediated transport induced)

• rifapentine
Brilinta (ticagrelor)

+

rifapentine

1 interaction

Avoid/Use Alternative

ticagrelor + rifapentine

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced, P-gp-mediated transport possibly induced)

• ritonavir
Brilinta (ticagrelor)

+

ritonavir

1 interaction

Avoid/Use Alternative

ticagrelor + ritonavir

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, PR interval prolongation, AV block, bradycardia, other adverse effects (hepatic metabolism inhibited, additive effects)

• rivaroxaban
Brilinta (ticagrelor)

+

rivaroxaban

1 interaction

Avoid/Use Alternative

ticagrelor + rivaroxaban

avoid combo if also combined w/ strong CYP3A4 inhibitor; use alternative if CrCl <80 and combined w/ moderate CYP3A4 inhibitor; otherwise, monitor bleeding s/sx: combo may incr. rivaroxaban levels, risk of bleeding (including life-threatening), other adverse effects (BCRP-mediated transport inhibited, P-gp-mediated transport inhibited, additive effects)

• simvastatin
Brilinta (ticagrelor)

+

simvastatin

1 interaction

Avoid/Use Alternative

ticagrelor + simvastatin

use alternative or monitor CK, myopathy sx; adjust max simvastatin dose to 40 mg/day: combo may incr. simvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited, BCRP-mediated transport inhibited)

• siponimod
Brilinta (ticagrelor)

+

siponimod

1 interaction

Avoid/Use Alternative

ticagrelor + siponimod

consider alternative or monitor HR, ECG, especially when starting or restarting siponimod tx: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• sirolimus albumin-bound
Brilinta (ticagrelor)

+

sirolimus albumin-bound

1 interaction

Avoid/Use Alternative

ticagrelor + sirolimus albumin-bound

avoid combo: combo may incr. sirolimus albumin-bound levels, risk of serious infection, myelosuppression, bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, additive effects)

• sotorasib
Brilinta (ticagrelor)

+

sotorasib

1 interaction

Avoid/Use Alternative

ticagrelor + sotorasib

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced)

• St. John's wort
Brilinta (ticagrelor)

+

St. John's wort

1 interaction

Avoid/Use Alternative

ticagrelor + St. John's wort

avoid combo: combo may decr. ticagrelor levels, efficacy (hepatic metabolism induced, P-gp-mediated transport induced)

• sufentanil
Brilinta (ticagrelor)

+

sufentanil

1 interaction

Avoid/Use Alternative

ticagrelor + sufentanil

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, monitor respiratory rate, HR, consider decr. sufentanil dose or frequency: combo may incr. sufentanil levels, risk of CNS and respiratory depression, psychomotor impairment, bradycardia, other adverse effects; may decr. ticagrelor and active metabolite levels, efficacy (hepatic metabolism inhibited, additive effects; absorption of ticagrelor possibly affected by delayed gastric emptying)

• tapentadol
Brilinta (ticagrelor)

+

tapentadol

1 interaction

Avoid/Use Alternative

ticagrelor + tapentadol

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• tipranavir
Brilinta (ticagrelor)

+

tipranavir

1 interaction

Avoid/Use Alternative

ticagrelor + tipranavir

avoid combo: combo may incr. or decr. ticagrelor levels, incr. risk of dyspnea, bleeding (including life-threatening), other adverse effects or decr. efficacy (hepatic metabolism inhibited, P-gp-mediated transport possibly induced, additive effects)

• topotecan
Brilinta (ticagrelor)

+

topotecan

1 interaction

Avoid/Use Alternative

ticagrelor + topotecan

avoid combo w/ oral topotecan: combo may incr. topotecan levels, risk of serious infection, myelosuppression, other adverse effects (gut P-gp-mediated transport inhibited, gut BCRP-mediated transport inhibited)

• tramadol
Brilinta (ticagrelor)

+

tramadol

1 interaction

Avoid/Use Alternative

ticagrelor + tramadol

consider alternative parenteral antiplatelet agent for acute tx of ACS; otherwise, caution advised: combo may decr. ticagrelor and active metabolite levels, efficacy (absorption of ticagrelor possibly affected by delayed gastric emptying)

• tucatinib
Brilinta (ticagrelor)

+

tucatinib

1 interaction

Avoid/Use Alternative

ticagrelor + tucatinib

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• venetoclax
Brilinta (ticagrelor)

+

venetoclax

1 interaction

Avoid/Use Alternative

ticagrelor + venetoclax

monitor CBC, tumor lysis syndrome s/sx; CLL/SLL: consider alternative or decr. venetoclax dose by at least 50%; AML: decr. venetoclax dose by at least 50%: combo may incr. venetoclax levels, risk of serious infection, myelosuppression, tumor lysis syndrome, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• voriconazole
Brilinta (ticagrelor)

+

voriconazole

1 interaction

Avoid/Use Alternative

ticagrelor + voriconazole

avoid combo: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

Monitor/Modify Tx

• abemaciclib
Brilinta (ticagrelor)

+

abemaciclib

1 interaction

Monitor/Modify Tx

ticagrelor + abemaciclib

monitor CBC: combo may incr. abemaciclib levels, risk of serious infection, myelosuppression, thrombosis risk, other adverse effects (hepatic metabolism inhibited)

• acalabrutinib
Brilinta (ticagrelor)

+

acalabrutinib

1 interaction

Monitor/Modify Tx

ticagrelor + acalabrutinib

monitor bleeding s/sx, CBC: combo may incr. acalabrutinib levels, risk of bleeding (including life-threatening), serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited, additive effects)

• acebutolol
Brilinta (ticagrelor)

+

acebutolol

1 interaction

Monitor/Modify Tx

ticagrelor + acebutolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• adenosine
Brilinta (ticagrelor)

+

adenosine

1 interaction

Monitor/Modify Tx

ticagrelor + adenosine

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• ado-trastuzumab emtansine
Brilinta (ticagrelor)

+

ado-trastuzumab emtansine

1 interaction

Monitor/Modify Tx

ticagrelor + ado-trastuzumab emtansine

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• afatinib
Brilinta (ticagrelor)

+

afatinib

1 interaction

Monitor/Modify Tx

ticagrelor + afatinib

monitor bleeding s/sx; decr. afatinib dose by 10 mg/day if not tolerated: combo may incr. afatinib levels, risk of GI or other bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• alectinib
Brilinta (ticagrelor)

+

alectinib

1 interaction

Monitor/Modify Tx

ticagrelor + alectinib

monitor HR: combo may incr. risk of bradycardia (additive effects)

• alpha-tocopherol (vitamin E)
Brilinta (ticagrelor)

+

alpha-tocopherol (vitamin E)

1 interaction

Monitor/Modify Tx

ticagrelor + alpha-tocopherol (vitamin E)

monitor bleeding signs/symptoms, especially with alpha-tocopherol doses >800 units/day: combo may increase risk of bleeding, including life-threatening (additive effects)

• alprostadil intracavernous
Brilinta (ticagrelor)

+

alprostadil intracavernous

1 interaction

Monitor/Modify Tx

ticagrelor + alprostadil intracavernous

monitor injection site bleeding signs/symptoms: combo may increase risk of localized bleeding (additive effects)

• alprostadil intravenous
Brilinta (ticagrelor)

+

alprostadil intravenous

1 interaction

Monitor/Modify Tx

ticagrelor + alprostadil intravenous

monitor bleeding signs/symptoms: combo may increase risk of bleeding, including life-threatening (additive effects)

• alteplase
Brilinta (ticagrelor)

+

alteplase

1 interaction

Monitor/Modify Tx

ticagrelor + alteplase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• amiodarone
Brilinta (ticagrelor)

+

amiodarone

1 interaction

Monitor/Modify Tx

ticagrelor + amiodarone

monitor ECG, HR: combo may incr. amiodarone levels, risk of QT and PR interval prolongation, cardiac arrhythmias, AV block, bradycardia, other adverse effects (hepatic metabolism inhibited, additive effects)

• anacaulase topical
Brilinta (ticagrelor)

+

anacaulase topical

1 interaction

Monitor/Modify Tx

ticagrelor + anacaulase topical

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• anagrelide
Brilinta (ticagrelor)

+

anagrelide

1 interaction

Monitor/Modify Tx

ticagrelor + anagrelide

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• antithrombin
Brilinta (ticagrelor)

+

antithrombin

1 interaction

Monitor/Modify Tx

ticagrelor + antithrombin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• apraclonidine ophthalmic
Brilinta (ticagrelor)

+

apraclonidine ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + apraclonidine ophthalmic

monitor HR if apraclonidine IOP adjunct use; postop use OK: combo may incr. risk of bradycardia (additive effects)

• argatroban
Brilinta (ticagrelor)

+

argatroban

1 interaction

Monitor/Modify Tx

ticagrelor + argatroban

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• arsenic trioxide
Brilinta (ticagrelor)

+

arsenic trioxide

1 interaction

Monitor/Modify Tx

ticagrelor + arsenic trioxide

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• articaine
Brilinta (ticagrelor)

+

articaine

1 interaction

Monitor/Modify Tx

ticagrelor + articaine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• asparaginase
Brilinta (ticagrelor)

+

asparaginase

1 interaction

Monitor/Modify Tx

ticagrelor + asparaginase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• aspirin
Brilinta (ticagrelor)

+

aspirin

1 interaction

Monitor/Modify Tx

ticagrelor + aspirin

monitor bleeding s/sx; limit aspirin maint. doses to 75-100 mg/day: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• atenolol
Brilinta (ticagrelor)

+

atenolol

1 interaction

Monitor/Modify Tx

ticagrelor + atenolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• atorvastatin
Brilinta (ticagrelor)

+

atorvastatin

1 interaction

Monitor/Modify Tx

ticagrelor + atorvastatin

monitor CK, myopathy sx: combo may incr. atorvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (P-gp-mediated transport inhibited, BCRP-mediated transport inhibited)

• avanafil
Brilinta (ticagrelor)

+

avanafil

1 interaction

Monitor/Modify Tx

ticagrelor + avanafil

monitor BP; consider decr. avanafil dose: combo may incr. avanafil levels, risk of hypotension, priapism, other adverse effects (hepatic metabolism inhibited)

• avapritinib
Brilinta (ticagrelor)

+

avapritinib

1 interaction

Monitor/Modify Tx

ticagrelor + avapritinib

monitor bleeding s/sx: combo may incr. avapritinib levels, risk of bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• axitinib
Brilinta (ticagrelor)

+

axitinib

1 interaction

Monitor/Modify Tx

ticagrelor + axitinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• betaxolol
Brilinta (ticagrelor)

+

betaxolol

1 interaction

Monitor/Modify Tx

ticagrelor + betaxolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• betaxolol ophthalmic
Brilinta (ticagrelor)

+

betaxolol ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + betaxolol ophthalmic

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• bevacizumab
Brilinta (ticagrelor)

+

bevacizumab

1 interaction

Monitor/Modify Tx

ticagrelor + bevacizumab

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• binimetinib
Brilinta (ticagrelor)

+

binimetinib

1 interaction

Monitor/Modify Tx

ticagrelor + binimetinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• bisoprolol
Brilinta (ticagrelor)

+

bisoprolol

1 interaction

Monitor/Modify Tx

ticagrelor + bisoprolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• bivalirudin
Brilinta (ticagrelor)

+

bivalirudin

1 interaction

Monitor/Modify Tx

ticagrelor + bivalirudin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• brentuximab vedotin
Brilinta (ticagrelor)

+

brentuximab vedotin

1 interaction

Monitor/Modify Tx

ticagrelor + brentuximab vedotin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• bromelain
Brilinta (ticagrelor)

+

bromelain

1 interaction

Monitor/Modify Tx

ticagrelor + bromelain

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• bromfenac ophthalmic
Brilinta (ticagrelor)

+

bromfenac ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + bromfenac ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• bupivacaine
Brilinta (ticagrelor)

+

bupivacaine

1 interaction

Monitor/Modify Tx

ticagrelor + bupivacaine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• bupivacaine liposomal
Brilinta (ticagrelor)

+

bupivacaine liposomal

1 interaction

Monitor/Modify Tx

ticagrelor + bupivacaine liposomal

monitor HR: combo may incr. risk of bradycardia (additive effects)

• cabazitaxel
Brilinta (ticagrelor)

+

cabazitaxel

1 interaction

Monitor/Modify Tx

ticagrelor + cabazitaxel

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• cabozantinib
Brilinta (ticagrelor)

+

cabozantinib

1 interaction

Monitor/Modify Tx

ticagrelor + cabozantinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• calaspargase
Brilinta (ticagrelor)

+

calaspargase

1 interaction

Monitor/Modify Tx

ticagrelor + calaspargase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• cangrelor
Brilinta (ticagrelor)

+

cangrelor

1 interaction

Monitor/Modify Tx

ticagrelor + cangrelor

may start ticagrelor during cangrelor infusion when transitioning to PO tx: combo may incr. risk of bleeding, including life-threatening (additive effects, duplicate therapy)

• capivasertib
Brilinta (ticagrelor)

+

capivasertib

1 interaction

Monitor/Modify Tx

ticagrelor + capivasertib

monitor glucose: combo may incr. capivasertib levels, risk of severe hyperglycemia, other adverse effects (hepatic metabolism inhibited)

• carfilzomib
Brilinta (ticagrelor)

+

carfilzomib

1 interaction

Monitor/Modify Tx

ticagrelor + carfilzomib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• carteolol ophthalmic
Brilinta (ticagrelor)

+

carteolol ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + carteolol ophthalmic

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• carvedilol
Brilinta (ticagrelor)

+

carvedilol

1 interaction

Monitor/Modify Tx

ticagrelor + carvedilol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• celecoxib
Brilinta (ticagrelor)

+

celecoxib

1 interaction

Monitor/Modify Tx

ticagrelor + celecoxib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• chloroprocaine
Brilinta (ticagrelor)

+

chloroprocaine

1 interaction

Monitor/Modify Tx

ticagrelor + chloroprocaine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• cilostazol
Brilinta (ticagrelor)

+

cilostazol

1 interaction

Monitor/Modify Tx

ticagrelor + cilostazol

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• citalopram
Brilinta (ticagrelor)

+

citalopram

1 interaction

Monitor/Modify Tx

ticagrelor + citalopram

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• clozapine
Brilinta (ticagrelor)

+

clozapine

1 interaction

Monitor/Modify Tx

ticagrelor + clozapine

monitor ECG, BP, HR; consider decr. clozapine dose: combo may incr. clozapine levels, risk of QT prolongation, cardiac arrhythmias, hypotension, severe bradycardia, other adverse effects (hepatic metabolism inhibited, additive effects)

• cysteamine
Brilinta (ticagrelor)

+

cysteamine

1 interaction

Monitor/Modify Tx

ticagrelor + cysteamine

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• dalteparin
Brilinta (ticagrelor)

+

dalteparin

1 interaction

Monitor/Modify Tx

ticagrelor + dalteparin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• dasatinib
Brilinta (ticagrelor)

+

dasatinib

1 interaction

Monitor/Modify Tx

ticagrelor + dasatinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• deferasirox
Brilinta (ticagrelor)

+

deferasirox

1 interaction

Monitor/Modify Tx

ticagrelor + deferasirox

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• defibrotide
Brilinta (ticagrelor)

+

defibrotide

1 interaction

Monitor/Modify Tx

ticagrelor + defibrotide

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• desvenlafaxine
Brilinta (ticagrelor)

+

desvenlafaxine

1 interaction

Monitor/Modify Tx

ticagrelor + desvenlafaxine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• deuruxolitinib
Brilinta (ticagrelor)

+

deuruxolitinib

1 interaction

Monitor/Modify Tx

ticagrelor + deuruxolitinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• dexmedetomidine
Brilinta (ticagrelor)

+

dexmedetomidine

1 interaction

Monitor/Modify Tx

ticagrelor + dexmedetomidine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• dexmedetomidine injection
Brilinta (ticagrelor)

+

dexmedetomidine injection

1 interaction

Monitor/Modify Tx

ticagrelor + dexmedetomidine injection

monitor HR: combo may incr. risk of bradycardia (additive effects)

• diclofenac
Brilinta (ticagrelor)

+

diclofenac

1 interaction

Monitor/Modify Tx

ticagrelor + diclofenac

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• diclofenac ophthalmic
Brilinta (ticagrelor)

+

diclofenac ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + diclofenac ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• diclofenac topical
Brilinta (ticagrelor)

+

diclofenac topical

1 interaction

Monitor/Modify Tx

ticagrelor + diclofenac topical

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• diflunisal
Brilinta (ticagrelor)

+

diflunisal

1 interaction

Monitor/Modify Tx

ticagrelor + diflunisal

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• digoxin
Brilinta (ticagrelor)

+

digoxin

1 interaction

Monitor/Modify Tx

ticagrelor + digoxin

monitor digoxin levels, HR; decr. digoxin frequency or dose by 15-30%: combo may incr. digoxin levels, risk of PR interval prolongation, bradycardia, AV block, other adverse effects (P-gp-mediated transport inhibited, additive effects)

• diltiazem
Brilinta (ticagrelor)

+

diltiazem

1 interaction

Monitor/Modify Tx

ticagrelor + diltiazem

monitor HR, consider monitoring ECG: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, PR interval prolongation, AV block, bradycardia, other adverse effects (hepatic metabolism inhibited, additive effects)

• dimethyl fumarate
Brilinta (ticagrelor)

+

dimethyl fumarate

1 interaction

Monitor/Modify Tx

ticagrelor + dimethyl fumarate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• diosmin
Brilinta (ticagrelor)

+

diosmin

1 interaction

Monitor/Modify Tx

ticagrelor + diosmin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• dipyridamole
Brilinta (ticagrelor)

+

dipyridamole

1 interaction

Monitor/Modify Tx

ticagrelor + dipyridamole

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• diroximel fumarate
Brilinta (ticagrelor)

+

diroximel fumarate

1 interaction

Monitor/Modify Tx

ticagrelor + diroximel fumarate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• disopyramide
Brilinta (ticagrelor)

+

disopyramide

1 interaction

Monitor/Modify Tx

ticagrelor + disopyramide

monitor disopyramide levels, HR, ECG: combo may incr. disopyramide levels, risk of QT and PR interval prolongation, cardiac arrhythmias, AV block, bradycardia, other adverse effects; may aggravate or precipitate CHF (hepatic metabolism inhibited, additive effects)

• docetaxel
Brilinta (ticagrelor)

+

docetaxel

1 interaction

Monitor/Modify Tx

ticagrelor + docetaxel

monitor CBC: combo may incr. docetaxel levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• dofetilide
Brilinta (ticagrelor)

+

dofetilide

1 interaction

Monitor/Modify Tx

ticagrelor + dofetilide

monitor ECG: combo may incr. dofetilide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• domperidone
Brilinta (ticagrelor)

+

domperidone

1 interaction

Monitor/Modify Tx

ticagrelor + domperidone

monitor ECG, HR, electrolytes: combo may incr. domperidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• donanemab
Brilinta (ticagrelor)

+

donanemab

1 interaction

Monitor/Modify Tx

ticagrelor + donanemab

monitor bleeding s/sx: combo may incr. risk of intracerebral bleeding, including life-threatening (additive effects)

• donepezil
Brilinta (ticagrelor)

+

donepezil

1 interaction

Monitor/Modify Tx

ticagrelor + donepezil

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• dronedarone
Brilinta (ticagrelor)

+

dronedarone

1 interaction

Monitor/Modify Tx

ticagrelor + dronedarone

monitor HR, ECG: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, PR interval prolongation, AV block, bradycardia, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, additive effects)

• dulaglutide
Brilinta (ticagrelor)

+

dulaglutide

1 interaction

Monitor/Modify Tx

ticagrelor + dulaglutide

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• duloxetine
Brilinta (ticagrelor)

+

duloxetine

1 interaction

Monitor/Modify Tx

ticagrelor + duloxetine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• edoxaban
Brilinta (ticagrelor)

+

edoxaban

1 interaction

Monitor/Modify Tx

ticagrelor + edoxaban

monitor bleeding s/sx: combo may incr. edoxaban levels, risk of bleeding (including life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

• enfortumab vedotin
Brilinta (ticagrelor)

+

enfortumab vedotin

1 interaction

Monitor/Modify Tx

ticagrelor + enfortumab vedotin

if also combined w/ strong CYP3A4 inhibitor, monitor CBC, glucose: combo may incr. enfortumab vedotin levels, risk of myelosuppression, neuropathy, hyperglycemia, other adverse effects (P-gp-mediated transport inhibited)

• entrectinib
Brilinta (ticagrelor)

+

entrectinib

1 interaction

Monitor/Modify Tx

ticagrelor + entrectinib

monitor ECG, CBC: combo may incr. entrectinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metabolism inhibited)

• eplerenone
Brilinta (ticagrelor)

+

eplerenone

1 interaction

Monitor/Modify Tx

ticagrelor + eplerenone

monitor potassium: combo may incr. eplerenone levels, risk of hyperkalemia, other adverse effects (hepatic metabolism inhibited)

• epoprostenol
Brilinta (ticagrelor)

+

epoprostenol

1 interaction

Monitor/Modify Tx

ticagrelor + epoprostenol

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• eptifibatide
Brilinta (ticagrelor)

+

eptifibatide

1 interaction

Monitor/Modify Tx

ticagrelor + eptifibatide

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• erlotinib
Brilinta (ticagrelor)

+

erlotinib

1 interaction

Monitor/Modify Tx

ticagrelor + erlotinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• erythromycin
Brilinta (ticagrelor)

+

erythromycin

1 interaction

Monitor/Modify Tx

ticagrelor + erythromycin

monitor ECG: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, dyspnea, bleeding, other adverse effects (hepatic metabolism inhibited)

• escitalopram
Brilinta (ticagrelor)

+

escitalopram

1 interaction

Monitor/Modify Tx

ticagrelor + escitalopram

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• esmolol
Brilinta (ticagrelor)

+

esmolol

1 interaction

Monitor/Modify Tx

ticagrelor + esmolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• ethanol (alcoholic beverage)
Brilinta (ticagrelor)

+

ethanol (alcoholic beverage)

1 interaction

Monitor/Modify Tx

ticagrelor + ethanol (alcoholic beverage)

monitor bleeding signs/symptoms: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• etodolac
Brilinta (ticagrelor)

+

etodolac

1 interaction

Monitor/Modify Tx

ticagrelor + etodolac

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• etripamil nasal
Brilinta (ticagrelor)

+

etripamil nasal

1 interaction

Monitor/Modify Tx

ticagrelor + etripamil nasal

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• evening primrose oil
Brilinta (ticagrelor)

+

evening primrose oil

1 interaction

Monitor/Modify Tx

ticagrelor + evening primrose oil

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• everolimus
Brilinta (ticagrelor)

+

everolimus

1 interaction

Monitor/Modify Tx

ticagrelor + everolimus

TSC-ASSOC. SEGA, TSC-ASSOC. PARTIAL ONSET SEIZURES, TRANSPLANT: monitor everolimus levels, CBC; OTHER INDICATIONS: monitor CBC: combo may incr. everolimus levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• fedratinib
Brilinta (ticagrelor)

+

fedratinib

1 interaction

Monitor/Modify Tx

ticagrelor + fedratinib

if fedratinib also combined w/ CYP2C19 inhibitor, monitor CBC, LFTs; otherwise, caution advised: combo may incr. levels of both drugs, risk of dyspnea, bleeding, myelosuppression, hepatotoxicity, other adverse effects (hepatic metabolism inhibited)

• felodipine
Brilinta (ticagrelor)

+

felodipine

1 interaction

Monitor/Modify Tx

ticagrelor + felodipine

monitor BP, HR: combo may incr. felodipine levels, risk of hypotension, reflex tachycardia, other adverse effects (hepatic metabolism inhibited)

• fenoprofen
Brilinta (ticagrelor)

+

fenoprofen

1 interaction

Monitor/Modify Tx

ticagrelor + fenoprofen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• fenugreek
Brilinta (ticagrelor)

+

fenugreek

1 interaction

Monitor/Modify Tx

ticagrelor + fenugreek

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• finerenone
Brilinta (ticagrelor)

+

finerenone

1 interaction

Monitor/Modify Tx

ticagrelor + finerenone

monitor potassium: combo may incr. finerenone levels, risk of hyperkalemia, other adverse effects (hepatic metabolism inhibited)

• flecainide
Brilinta (ticagrelor)

+

flecainide

1 interaction

Monitor/Modify Tx

ticagrelor + flecainide

monitor HR, ECG: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• flibanserin
Brilinta (ticagrelor)

+

flibanserin

1 interaction

Monitor/Modify Tx

ticagrelor + flibanserin

monitor BP, especially if flibanserin also combined w/ other weak CYP3A4 inhibitors: combo may incr. flibanserin levels, risk of CNS depression, psychomotor impairment, severe hypotension (including syncope), other adverse effects (hepatic metabolism inhibited)

• fluoxetine
Brilinta (ticagrelor)

+

fluoxetine

1 interaction

Monitor/Modify Tx

ticagrelor + fluoxetine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• flurbiprofen
Brilinta (ticagrelor)

+

flurbiprofen

1 interaction

Monitor/Modify Tx

ticagrelor + flurbiprofen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• flurbiprofen ophthalmic
Brilinta (ticagrelor)

+

flurbiprofen ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + flurbiprofen ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• fluvastatin
Brilinta (ticagrelor)

+

fluvastatin

1 interaction

Monitor/Modify Tx

ticagrelor + fluvastatin

monitor CK, myopathy sx: combo may incr. fluvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (BCRP-mediated transport inhibited)

• fluvoxamine
Brilinta (ticagrelor)

+

fluvoxamine

1 interaction

Monitor/Modify Tx

ticagrelor + fluvoxamine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• fruquintinib
Brilinta (ticagrelor)

+

fruquintinib

1 interaction

Monitor/Modify Tx

ticagrelor + fruquintinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• gadobenate dimeglumine
Brilinta (ticagrelor)

+

gadobenate dimeglumine

1 interaction

Monitor/Modify Tx

ticagrelor + gadobenate dimeglumine

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• galantamine
Brilinta (ticagrelor)

+

galantamine

1 interaction

Monitor/Modify Tx

ticagrelor + galantamine

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• garlic
Brilinta (ticagrelor)

+

garlic

1 interaction

Monitor/Modify Tx

ticagrelor + garlic

monitor bleeding s/sx, especially w/ supplemental garlic; dietary intake OK: combo may decr. ticagrelor levels, efficacy; may incr. risk of bleeding, including life-threatening (hepatic metabolism induced; additive effects)

• gefitinib
Brilinta (ticagrelor)

+

gefitinib

1 interaction

Monitor/Modify Tx

ticagrelor + gefitinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• gemtuzumab ozogamicin
Brilinta (ticagrelor)

+

gemtuzumab ozogamicin

1 interaction

Monitor/Modify Tx

ticagrelor + gemtuzumab ozogamicin

monitor platelets, bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• gepirone
Brilinta (ticagrelor)

+

gepirone

1 interaction

Monitor/Modify Tx

ticagrelor + gepirone

monitor ECG, electrolytes: combo may incr. gepirone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• ginkgo
Brilinta (ticagrelor)

+

ginkgo

1 interaction

Monitor/Modify Tx

ticagrelor + ginkgo

monitor bleeding s/sx: combo may decr. ticagrelor levels, efficacy; may incr. risk of bleeding, including life-threatening (hepatic metabolism induced; additive effects)

• guanfacine
Brilinta (ticagrelor)

+

guanfacine

1 interaction

Monitor/Modify Tx

ticagrelor + guanfacine

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• heparin
Brilinta (ticagrelor)

+

heparin

1 interaction

Monitor/Modify Tx

ticagrelor + heparin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• hydrocortisone
Brilinta (ticagrelor)

+

hydrocortisone

1 interaction

Monitor/Modify Tx

ticagrelor + hydrocortisone

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ibrutinib
Brilinta (ticagrelor)

+

ibrutinib

1 interaction

Monitor/Modify Tx

ticagrelor + ibrutinib

monitor bleeding s/sx; consider decr. ibrutinib dose: combo may incr. ibrutinib levels, risk of bleeding (including life-threatening), serious infection, myelosuppression, other adverse effects (hepatic metabolism inhibited, additive effects)

• ibuprofen
Brilinta (ticagrelor)

+

ibuprofen

1 interaction

Monitor/Modify Tx

ticagrelor + ibuprofen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ibuprofen lysine
Brilinta (ticagrelor)

+

ibuprofen lysine

1 interaction

Monitor/Modify Tx

ticagrelor + ibuprofen lysine

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• icosapent ethyl
Brilinta (ticagrelor)

+

icosapent ethyl

1 interaction

Monitor/Modify Tx

ticagrelor + icosapent ethyl

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• imatinib
Brilinta (ticagrelor)

+

imatinib

1 interaction

Monitor/Modify Tx

ticagrelor + imatinib

monitor bleeding signs/symptoms: combo may incr. ticagrelor levels, risk of dyspnea, GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• indomethacin
Brilinta (ticagrelor)

+

indomethacin

1 interaction

Monitor/Modify Tx

ticagrelor + indomethacin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• irinotecan
Brilinta (ticagrelor)

+

irinotecan

1 interaction

Monitor/Modify Tx

ticagrelor + irinotecan

monitor CBC: combo may incr. irinotecan and active metabolite levels, risk of serious infection, myelosuppression, other toxicities (BCRP-mediated transport inhibited)

• ivabradine
Brilinta (ticagrelor)

+

ivabradine

1 interaction

Monitor/Modify Tx

ticagrelor + ivabradine

monitor HR, ECG: combo may incr. ivabradine levels, risk of PR interval prolongation, AV block, bradycardia, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited, additive effects)

• ixabepilone
Brilinta (ticagrelor)

+

ixabepilone

1 interaction

Monitor/Modify Tx

ticagrelor + ixabepilone

monitor CBC: combo may incr. ixabepilone levels, risk of serious infection, myelosuppression, other toxicity (hepatic metabolism inhibited)

• ketoprofen
Brilinta (ticagrelor)

+

ketoprofen

1 interaction

Monitor/Modify Tx

ticagrelor + ketoprofen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ketorolac
Brilinta (ticagrelor)

+

ketorolac

1 interaction

Monitor/Modify Tx

ticagrelor + ketorolac

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ketorolac ophthalmic
Brilinta (ticagrelor)

+

ketorolac ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + ketorolac ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• labetalol
Brilinta (ticagrelor)

+

labetalol

1 interaction

Monitor/Modify Tx

ticagrelor + labetalol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• lacosamide
Brilinta (ticagrelor)

+

lacosamide

1 interaction

Monitor/Modify Tx

ticagrelor + lacosamide

monitor HR, ECG, especially during lacosamide initiation/titration: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• lamotrigine
Brilinta (ticagrelor)

+

lamotrigine

1 interaction

Monitor/Modify Tx

ticagrelor + lamotrigine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• lanreotide
Brilinta (ticagrelor)

+

lanreotide

1 interaction

Monitor/Modify Tx

ticagrelor + lanreotide

monitor HR: combo may incr. risk of bradycardia (additive effects)

• lapatinib
Brilinta (ticagrelor)

+

lapatinib

1 interaction

Monitor/Modify Tx

ticagrelor + lapatinib

monitor ECG: combo may incr. lapatinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (BCRP-mediated transport inhibited)

• lecanemab
Brilinta (ticagrelor)

+

lecanemab

1 interaction

Monitor/Modify Tx

ticagrelor + lecanemab

monitor bleeding s/sx: combo may incr. risk of intracerebral bleeding, including life-threatening (additive effects)

• lemborexant
Brilinta (ticagrelor)

+

lemborexant

1 interaction

Monitor/Modify Tx

ticagrelor + lemborexant

adjust max lemborexant dose to 5 mg/day: combo may incr. lemborexant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• lenvatinib
Brilinta (ticagrelor)

+

lenvatinib

1 interaction

Monitor/Modify Tx

ticagrelor + lenvatinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• levobunolol ophthalmic
Brilinta (ticagrelor)

+

levobunolol ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + levobunolol ophthalmic

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• levomilnacipran
Brilinta (ticagrelor)

+

levomilnacipran

1 interaction

Monitor/Modify Tx

ticagrelor + levomilnacipran

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• lidocaine
Brilinta (ticagrelor)

+

lidocaine

1 interaction

Monitor/Modify Tx

ticagrelor + lidocaine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• lifileucel
Brilinta (ticagrelor)

+

lifileucel

1 interaction

Monitor/Modify Tx

ticagrelor + lifileucel

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• lomitapide
Brilinta (ticagrelor)

+

lomitapide

1 interaction

Monitor/Modify Tx

ticagrelor + lomitapide

ADULT PATIENTS: if patient on stable ticagrelor dose and starting lomitapide, adjust max lomitapide dose to 30 mg/day; if patient on stable lomitapide dose and starting ticagrelor, decr. lomitapide dose by 50% and adjust max lomitapide dose to 30 mg/day; PEDIATRIC PATIENTS: if patient on stable ticagrelor dose and starting lomitapide, adjust max lomitapide dose to 10 mg/day if 2-10 yo or 20 mg/day if 11-17 yo; if patient on stable lomitapide dose and starting ticagrelor, decr. lomitapide dose by 50% and adjust max lomitapide dose to 10 mg/day if 2-10 yo or 20 mg/day if 11-17 yo: combo may incr. lomitapide levels, risk of hepatotoxicity, other adverse effects (hepatic metabolism inhibited)

• lumateperone
Brilinta (ticagrelor)

+

lumateperone

1 interaction

Monitor/Modify Tx

ticagrelor + lumateperone

monitor ECG: combo may incr. lumateperone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• lurasidone
Brilinta (ticagrelor)

+

lurasidone

1 interaction

Monitor/Modify Tx

ticagrelor + lurasidone

monitor ECG: combo may incr. lurasidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• lurbinectedin
Brilinta (ticagrelor)

+

lurbinectedin

1 interaction

Monitor/Modify Tx

ticagrelor + lurbinectedin

monitor CBC: combo may incr. lurbinectedin levels, risk of myelosuppression, other adverse effects (hepatic metabolism inhibited)

• magnesium salicylate
Brilinta (ticagrelor)

+

magnesium salicylate

1 interaction

Monitor/Modify Tx

ticagrelor + magnesium salicylate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• mavorixafor
Brilinta (ticagrelor)

+

mavorixafor

1 interaction

Monitor/Modify Tx

ticagrelor + mavorixafor

monitor ECG: combo may incr. mavorixafor levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (P-gp-mediated transport inhibited)

• meclofenamate
Brilinta (ticagrelor)

+

meclofenamate

1 interaction

Monitor/Modify Tx

ticagrelor + meclofenamate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• mefenamic acid
Brilinta (ticagrelor)

+

mefenamic acid

1 interaction

Monitor/Modify Tx

ticagrelor + mefenamic acid

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• mefloquine
Brilinta (ticagrelor)

+

mefloquine

1 interaction

Monitor/Modify Tx

ticagrelor + mefloquine

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• meloxicam
Brilinta (ticagrelor)

+

meloxicam

1 interaction

Monitor/Modify Tx

ticagrelor + meloxicam

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• mepivacaine
Brilinta (ticagrelor)

+

mepivacaine

1 interaction

Monitor/Modify Tx

ticagrelor + mepivacaine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• methotrexate
Brilinta (ticagrelor)

+

methotrexate

1 interaction

Monitor/Modify Tx

ticagrelor + methotrexate

monitor CBC, renal fxn, bleeding s/sx: combo may incr. methotrexate levels, risk of serious infection, myelosuppression, nephrotoxicity, GI or other bleeding (including life-threatening), other adverse effects (BCRP-mediated transport inhibited, additive effects)

• methyl salicylate topical
Brilinta (ticagrelor)

+

methyl salicylate topical

1 interaction

Monitor/Modify Tx

ticagrelor + methyl salicylate topical

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, systemic salicylate absorption may occur from topical use)

• metoprolol
Brilinta (ticagrelor)

+

metoprolol

1 interaction

Monitor/Modify Tx

ticagrelor + metoprolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• midazolam
Brilinta (ticagrelor)

+

midazolam

1 interaction

Monitor/Modify Tx

ticagrelor + midazolam

monitor respiratory rate: combo may incr. midazolam and active metabolite levels, risk of profound CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• midodrine
Brilinta (ticagrelor)

+

midodrine

1 interaction

Monitor/Modify Tx

ticagrelor + midodrine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• milnacipran
Brilinta (ticagrelor)

+

milnacipran

1 interaction

Monitor/Modify Tx

ticagrelor + milnacipran

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• mitoxantrone
Brilinta (ticagrelor)

+

mitoxantrone

1 interaction

Monitor/Modify Tx

ticagrelor + mitoxantrone

monitor CBC, cardiac fxn, incl. LVEF: combo may incr. mitoxantrone levels, risk of serious infection, myelosuppression, cardiotoxicity, other adverse effects (BCRP-mediated transport inhibited)

• mobocertinib
Brilinta (ticagrelor)

+

mobocertinib

1 interaction

Monitor/Modify Tx

ticagrelor + mobocertinib

monitor ECG: combo may incr. mobocertinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may decr. ticagrelor levels, efficacy (hepatic metabolism inhibited; hepatic metabolism induced)

• monomethyl fumarate
Brilinta (ticagrelor)

+

monomethyl fumarate

1 interaction

Monitor/Modify Tx

ticagrelor + monomethyl fumarate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• mycophenolate mofetil
Brilinta (ticagrelor)

+

mycophenolate mofetil

1 interaction

Monitor/Modify Tx

ticagrelor + mycophenolate mofetil

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• mycophenolic acid
Brilinta (ticagrelor)

+

mycophenolic acid

1 interaction

Monitor/Modify Tx

ticagrelor + mycophenolic acid

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• nabumetone
Brilinta (ticagrelor)

+

nabumetone

1 interaction

Monitor/Modify Tx

ticagrelor + nabumetone

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• nadolol
Brilinta (ticagrelor)

+

nadolol

1 interaction

Monitor/Modify Tx

ticagrelor + nadolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• naproxen
Brilinta (ticagrelor)

+

naproxen

1 interaction

Monitor/Modify Tx

ticagrelor + naproxen

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• nattokinase
Brilinta (ticagrelor)

+

nattokinase

1 interaction

Monitor/Modify Tx

ticagrelor + nattokinase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• nebivolol
Brilinta (ticagrelor)

+

nebivolol

1 interaction

Monitor/Modify Tx

ticagrelor + nebivolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• neostigmine
Brilinta (ticagrelor)

+

neostigmine

1 interaction

Monitor/Modify Tx

ticagrelor + neostigmine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• nepafenac ophthalmic
Brilinta (ticagrelor)

+

nepafenac ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + nepafenac ophthalmic

monitor bleeding s/sx: combo may incr. risk of postop ocular bleeding (additive effects)

• niacin (vitamin B3)
Brilinta (ticagrelor)

+

niacin (vitamin B3)

1 interaction

Monitor/Modify Tx

ticagrelor + niacin (vitamin B3)

monitor platelets, bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• nifedipine
Brilinta (ticagrelor)

+

nifedipine

1 interaction

Monitor/Modify Tx

ticagrelor + nifedipine

monitor BP, consider lowest nifedipine start dose: combo may incr. nifedipine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• nilotinib
Brilinta (ticagrelor)

+

nilotinib

1 interaction

Monitor/Modify Tx

ticagrelor + nilotinib

monitor bleeding s/sx: combo may incr. ticagrelor levels, risk of dyspnea, GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• nimodipine
Brilinta (ticagrelor)

+

nimodipine

1 interaction

Monitor/Modify Tx

ticagrelor + nimodipine

monitor BP: combo may incr. nimodipine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• nintedanib
Brilinta (ticagrelor)

+

nintedanib

1 interaction

Monitor/Modify Tx

ticagrelor + nintedanib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• nisoldipine
Brilinta (ticagrelor)

+

nisoldipine

1 interaction

Monitor/Modify Tx

ticagrelor + nisoldipine

monitor BP: combo may incr. nisoldipine levels, risk of hypotension, other adverse effects (hepatic metabolism inhibited)

• nusinersen
Brilinta (ticagrelor)

+

nusinersen

1 interaction

Monitor/Modify Tx

ticagrelor + nusinersen

monitor platelets, bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• obinutuzumab
Brilinta (ticagrelor)

+

obinutuzumab

1 interaction

Monitor/Modify Tx

ticagrelor + obinutuzumab

monitor platelets, bleeding s/sx; consider holding ticagrelor, especially during first obinutuzumab cycle: combo may incr. risk of severe bleeding, including life-threatening (additive effects)

• octreotide
Brilinta (ticagrelor)

+

octreotide

1 interaction

Monitor/Modify Tx

ticagrelor + octreotide

monitor HR: combo may incr. risk of bradycardia (additive effects)

• omega-3-acid
Brilinta (ticagrelor)

+

omega-3-acid

1 interaction

Monitor/Modify Tx

ticagrelor + omega-3-acid

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• oxaliplatin
Brilinta (ticagrelor)

+

oxaliplatin

1 interaction

Monitor/Modify Tx

ticagrelor + oxaliplatin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• oxaprozin
Brilinta (ticagrelor)

+

oxaprozin

1 interaction

Monitor/Modify Tx

ticagrelor + oxaprozin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• paltusotine
Brilinta (ticagrelor)

+

paltusotine

1 interaction

Monitor/Modify Tx

ticagrelor + paltusotine

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• paroxetine
Brilinta (ticagrelor)

+

paroxetine

1 interaction

Monitor/Modify Tx

ticagrelor + paroxetine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• pasireotide
Brilinta (ticagrelor)

+

pasireotide

1 interaction

Monitor/Modify Tx

ticagrelor + pasireotide

monitor HR: combo may incr. risk of bradycardia (additive effects)

• pegaspargase
Brilinta (ticagrelor)

+

pegaspargase

1 interaction

Monitor/Modify Tx

ticagrelor + pegaspargase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• pemigatinib
Brilinta (ticagrelor)

+

pemigatinib

1 interaction

Monitor/Modify Tx

ticagrelor + pemigatinib

monitor phosphate: combo may incr. pemigatinib levels, risk of hyperphosphatemia, other adverse effects (hepatic metabolism inhibited)

• penicillin G
Brilinta (ticagrelor)

+

penicillin G

1 interaction

Monitor/Modify Tx

ticagrelor + penicillin G

monitor bleeding s/sx, especially w/ large penicillin G doses and/or concomitant renal impairment: combo may incr. risk of bleeding, including life-threatening (additive effects)

• pentosan polysulfate sodium
Brilinta (ticagrelor)

+

pentosan polysulfate sodium

1 interaction

Monitor/Modify Tx

ticagrelor + pentosan polysulfate sodium

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• pentoxifylline
Brilinta (ticagrelor)

+

pentoxifylline

1 interaction

Monitor/Modify Tx

ticagrelor + pentoxifylline

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• pindolol
Brilinta (ticagrelor)

+

pindolol

1 interaction

Monitor/Modify Tx

ticagrelor + pindolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• piperacillin
Brilinta (ticagrelor)

+

piperacillin

1 interaction

Monitor/Modify Tx

ticagrelor + piperacillin

monitor bleeding s/sx, especially w/ prolonged piperacillin tx and/or concomitant renal impairment: combo may incr. risk of bleeding, including life-threatening (additive effects)

• piroxicam
Brilinta (ticagrelor)

+

piroxicam

1 interaction

Monitor/Modify Tx

ticagrelor + piroxicam

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• pirtobrutinib
Brilinta (ticagrelor)

+

pirtobrutinib

1 interaction

Monitor/Modify Tx

ticagrelor + pirtobrutinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• pitavastatin
Brilinta (ticagrelor)

+

pitavastatin

1 interaction

Monitor/Modify Tx

ticagrelor + pitavastatin

monitor CK, myopathy sx: combo may incr. pitavastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (BCRP-mediated transport inhibited)

• plasminogen, human
Brilinta (ticagrelor)

+

plasminogen, human

1 interaction

Monitor/Modify Tx

ticagrelor + plasminogen, human

monitor bleeding s/sx, especially during and x4h after plasminogen infusion: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ponatinib
Brilinta (ticagrelor)

+

ponatinib

1 interaction

Monitor/Modify Tx

ticagrelor + ponatinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• porfimer
Brilinta (ticagrelor)

+

porfimer

1 interaction

Monitor/Modify Tx

ticagrelor + porfimer

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• pravastatin
Brilinta (ticagrelor)

+

pravastatin

1 interaction

Monitor/Modify Tx

ticagrelor + pravastatin

monitor CK, myopathy sx: combo may incr. pravastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (BCRP-mediated transport inhibited)

• praziquantel
Brilinta (ticagrelor)

+

praziquantel

1 interaction

Monitor/Modify Tx

ticagrelor + praziquantel

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• procainamide
Brilinta (ticagrelor)

+

procainamide

1 interaction

Monitor/Modify Tx

ticagrelor + procainamide

monitor HR, ECG: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• propofol
Brilinta (ticagrelor)

+

propofol

1 interaction

Monitor/Modify Tx

ticagrelor + propofol

monitor HR: combo may incr. risk of bradycardia (additive effects)

• propranolol
Brilinta (ticagrelor)

+

propranolol

1 interaction

Monitor/Modify Tx

ticagrelor + propranolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• pyridostigmine
Brilinta (ticagrelor)

+

pyridostigmine

1 interaction

Monitor/Modify Tx

ticagrelor + pyridostigmine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• quinidine (antiarrhythmic)
Brilinta (ticagrelor)

+

quinidine (antiarrhythmic)

1 interaction

Monitor/Modify Tx

ticagrelor + quinidine (antiarrhythmic)

monitor quinidine levels, ECG, HR: combo may incr. quinidine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects; may incr. risk of bradycardia (hepatic metabolism inhibited; P-gp-mediated transport inhibited; additive effects)

• quinine
Brilinta (ticagrelor)

+

quinine

1 interaction

Monitor/Modify Tx

ticagrelor + quinine

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• ramucirumab
Brilinta (ticagrelor)

+

ramucirumab

1 interaction

Monitor/Modify Tx

ticagrelor + ramucirumab

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• ranibizumab
Brilinta (ticagrelor)

+

ranibizumab

1 interaction

Monitor/Modify Tx

ticagrelor + ranibizumab

monitor bleeding s/sx; consider holding ticagrelor prior to implant insertion: combo may incr. risk of ocular hemorrhage (additive effects)

• ranolazine
Brilinta (ticagrelor)

+

ranolazine

1 interaction

Monitor/Modify Tx

ticagrelor + ranolazine

monitor ECG: combo may incr. ranolazine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (P-gp-mediated transport inhibited)

• red yeast rice
Brilinta (ticagrelor)

+

red yeast rice

1 interaction

Monitor/Modify Tx

ticagrelor + red yeast rice

monitor CK, myopathy sx w/ large amounts of red yeast rice: combo may incr. lovastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metabolism inhibited, red yeast rice contains varying amounts of lovastatin)

• regadenoson
Brilinta (ticagrelor)

+

regadenoson

1 interaction

Monitor/Modify Tx

ticagrelor + regadenoson

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• regorafenib
Brilinta (ticagrelor)

+

regorafenib

1 interaction

Monitor/Modify Tx

ticagrelor + regorafenib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• remibrutinib
Brilinta (ticagrelor)

+

remibrutinib

1 interaction

Monitor/Modify Tx

ticagrelor + remibrutinib

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• remimazolam
Brilinta (ticagrelor)

+

remimazolam

1 interaction

Monitor/Modify Tx

ticagrelor + remimazolam

monitor HR: combo may incr. risk of bradycardia (additive effects)

• resveratrol
Brilinta (ticagrelor)

+

resveratrol

1 interaction

Monitor/Modify Tx

ticagrelor + resveratrol

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• reteplase
Brilinta (ticagrelor)

+

reteplase

1 interaction

Monitor/Modify Tx

ticagrelor + reteplase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• revakinagene taroretcel
Brilinta (ticagrelor)

+

revakinagene taroretcel

1 interaction

Monitor/Modify Tx

ticagrelor + revakinagene taroretcel

monitor bleeding s/sx; hold ticagrelor prior to implant insertion: combo may incr. risk of ocular hemorrhage (additive effects)

• riociguat
Brilinta (ticagrelor)

+

riociguat

1 interaction

Monitor/Modify Tx

ticagrelor + riociguat

consider decr. riociguat start dose to 0.5 mg PO tid; monitor BP: combo may incr. riociguat levels, risk of severe hypotension, other adverse effects (BCRP-mediated transport inhibited)

• rivastigmine
Brilinta (ticagrelor)

+

rivastigmine

1 interaction

Monitor/Modify Tx

ticagrelor + rivastigmine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• ropivacaine
Brilinta (ticagrelor)

+

ropivacaine

1 interaction

Monitor/Modify Tx

ticagrelor + ropivacaine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• rosuvastatin
Brilinta (ticagrelor)

+

rosuvastatin

1 interaction

Monitor/Modify Tx

ticagrelor + rosuvastatin

monitor CK, myopathy sx, especially during initiation/titration: combo may incr. rosuvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (BCRP-mediated transport inhibited)

• salsalate
Brilinta (ticagrelor)

+

salsalate

1 interaction

Monitor/Modify Tx

ticagrelor + salsalate

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effect)

• saw palmetto
Brilinta (ticagrelor)

+

saw palmetto

1 interaction

Monitor/Modify Tx

ticagrelor + saw palmetto

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• selpercatinib
Brilinta (ticagrelor)

+

selpercatinib

1 interaction

Monitor/Modify Tx

ticagrelor + selpercatinib

monitor ECG, electrolytes, bleeding s/sx: combo may incr. selpercatinib levels, risk of QT prolongation, cardiac arrhythmias, bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• selumetinib
Brilinta (ticagrelor)

+

selumetinib

1 interaction

Monitor/Modify Tx

ticagrelor + selumetinib

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet and anticoagulant effects augmented by vitamin E content in selumetinib capsules)

• sepiapterin
Brilinta (ticagrelor)

+

sepiapterin

1 interaction

Monitor/Modify Tx

ticagrelor + sepiapterin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• sertraline
Brilinta (ticagrelor)

+

sertraline

1 interaction

Monitor/Modify Tx

ticagrelor + sertraline

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• sirolimus
Brilinta (ticagrelor)

+

sirolimus

1 interaction

Monitor/Modify Tx

ticagrelor + sirolimus

monitor sirolimus levels: combo may incr. sirolimus levels, risk of serious infection, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• sorafenib
Brilinta (ticagrelor)

+

sorafenib

1 interaction

Monitor/Modify Tx

ticagrelor + sorafenib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• sotalol
Brilinta (ticagrelor)

+

sotalol

1 interaction

Monitor/Modify Tx

ticagrelor + sotalol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• sotatercept
Brilinta (ticagrelor)

+

sotatercept

1 interaction

Monitor/Modify Tx

ticagrelor + sotatercept

monitor platelets, bleeding s/sx: combo may incr. risk of bleeding, including severe or life-threatening (additive effects)

• succinylcholine
Brilinta (ticagrelor)

+

succinylcholine

1 interaction

Monitor/Modify Tx

ticagrelor + succinylcholine

monitor HR: combo may incr. risk of bradycardia (additive effects)

• sugammadex
Brilinta (ticagrelor)

+

sugammadex

1 interaction

Monitor/Modify Tx

ticagrelor + sugammadex

monitor HR, bleeding s/sx, especially w/ sugammadex 16 mg/kg: combo may incr. risk of bradycardia, bleeding, including life-threatening (additive effects)

• sulindac
Brilinta (ticagrelor)

+

sulindac

1 interaction

Monitor/Modify Tx

ticagrelor + sulindac

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• sunitinib
Brilinta (ticagrelor)

+

sunitinib

1 interaction

Monitor/Modify Tx

ticagrelor + sunitinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• tacrolimus
Brilinta (ticagrelor)

+

tacrolimus

1 interaction

Monitor/Modify Tx

ticagrelor + tacrolimus

monitor tacrolimus levels, ECG, renal fxn: combo may incr. tacrolimus levels, risk of QT prolongation, cardiac arrhythmias, nephrotoxicity, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited)

• tadalafil
Brilinta (ticagrelor)

+

tadalafil

1 interaction

Monitor/Modify Tx

ticagrelor + tadalafil

monitor BP: combo may incr. tadalafil levels, risk of hypotension, priapism, other adverse effects (hepatic metabolism inhibited)

• talazoparib
Brilinta (ticagrelor)

+

talazoparib

1 interaction

Monitor/Modify Tx

ticagrelor + talazoparib

monitor CBC: combo may incr. talazoparib levels, risk of myelosuppression, other adverse effects (P-gp-mediated transport inhibited, BCRP-mediated transport inhibited)

• taletrectinib
Brilinta (ticagrelor)

+

taletrectinib

1 interaction

Monitor/Modify Tx

ticagrelor + taletrectinib

monitor ECG: combo may incr. taletrectinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metabolism inhibited)

• temsirolimus
Brilinta (ticagrelor)

+

temsirolimus

1 interaction

Monitor/Modify Tx

ticagrelor + temsirolimus

monitor CBC, bleeding signs/symptoms: combo may incr. temsirolimus and active metabolite sirolimus levels, risk of serious infection, myelosuppression, GI or other bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, additive effects)

• tenecteplase
Brilinta (ticagrelor)

+

tenecteplase

1 interaction

Monitor/Modify Tx

ticagrelor + tenecteplase

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• tenofovir alafenamide
Brilinta (ticagrelor)

+

tenofovir alafenamide

1 interaction

Monitor/Modify Tx

ticagrelor + tenofovir alafenamide

if tenofovir alafenamide not admin. w/ cobicistat, monitor renal fxn: combo may incr. tenofovir levels, risk of nephrotoxicity, other adverse effects (gut P-gp-mediated transport inhibited, gut BCRP-mediated transport inhibited)

• tenofovir disoproxil
Brilinta (ticagrelor)

+

tenofovir disoproxil

1 interaction

Monitor/Modify Tx

ticagrelor + tenofovir disoproxil

monitor renal fxn: combo may incr. tenofovir levels, risk of nephrotoxicity, other adverse effects (gut P-gp-mediated transport inhibited, gut BCRP-mediated transport inhibited)

• thalidomide
Brilinta (ticagrelor)

+

thalidomide

1 interaction

Monitor/Modify Tx

ticagrelor + thalidomide

monitor HR: combo may incr. risk of bradycardia (additive effects)

• timolol
Brilinta (ticagrelor)

+

timolol

1 interaction

Monitor/Modify Tx

ticagrelor + timolol

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• timolol ophthalmic
Brilinta (ticagrelor)

+

timolol ophthalmic

1 interaction

Monitor/Modify Tx

ticagrelor + timolol ophthalmic

monitor HR: combo may incr. risk of PR interval prolongation, AV block, bradycardia (additive effects)

• tirofiban
Brilinta (ticagrelor)

+

tirofiban

1 interaction

Monitor/Modify Tx

ticagrelor + tirofiban

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• tisotumab vedotin
Brilinta (ticagrelor)

+

tisotumab vedotin

1 interaction

Monitor/Modify Tx

ticagrelor + tisotumab vedotin

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• tivozanib
Brilinta (ticagrelor)

+

tivozanib

1 interaction

Monitor/Modify Tx

ticagrelor + tivozanib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• tolmetin
Brilinta (ticagrelor)

+

tolmetin

1 interaction

Monitor/Modify Tx

ticagrelor + tolmetin

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• tolvaptan
Brilinta (ticagrelor)

+

tolvaptan

1 interaction

Monitor/Modify Tx

ticagrelor + tolvaptan

consider decr. tolvaptan dose: combo may incr. tolvaptan levels, risk of adverse effects (hepatic metabolism inhibited)

• tovorafenib
Brilinta (ticagrelor)

+

tovorafenib

1 interaction

Monitor/Modify Tx

ticagrelor + tovorafenib

monitor bleeding s/sx: combo may decr. ticagrelor levels, efficacy; may incr. risk of bleeding, including life-threatening (hepatic metabolism induced; additive effects)

• trametinib
Brilinta (ticagrelor)

+

trametinib

1 interaction

Monitor/Modify Tx

ticagrelor + trametinib

monitor bleeding s/sx, especially w/ concomitant dabrafenib use: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• trazodone
Brilinta (ticagrelor)

+

trazodone

1 interaction

Monitor/Modify Tx

ticagrelor + trazodone

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• treprostinil
Brilinta (ticagrelor)

+

treprostinil

1 interaction

Monitor/Modify Tx

ticagrelor + treprostinil

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• triazolam
Brilinta (ticagrelor)

+

triazolam

1 interaction

Monitor/Modify Tx

ticagrelor + triazolam

monitor respiratory rate; consider decr. triazolam dose: combo may incr. triazolam levels, risk of CNS and respiratory depression, psychomotor impairment, other adverse effects (hepatic metabolism inhibited)

• ubrogepant
Brilinta (ticagrelor)

+

ubrogepant

1 interaction

Monitor/Modify Tx

ticagrelor + ubrogepant

limit ubrogepant dose to 50 mg, may give second 50 mg dose after 2h if needed: combo may incr. ubrogepant levels, risk of adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, BCRP-mediated transport inhibited)

• upadacitinib
Brilinta (ticagrelor)

+

upadacitinib

1 interaction

Monitor/Modify Tx

ticagrelor + upadacitinib

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• vadadustat
Brilinta (ticagrelor)

+

vadadustat

1 interaction

Monitor/Modify Tx

ticagrelor + vadadustat

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)

• valproic acid
Brilinta (ticagrelor)

+

valproic acid

1 interaction

Monitor/Modify Tx

ticagrelor + valproic acid

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• vandetanib
Brilinta (ticagrelor)

+

vandetanib

1 interaction

Monitor/Modify Tx

ticagrelor + vandetanib

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• vardenafil
Brilinta (ticagrelor)

+

vardenafil

1 interaction

Monitor/Modify Tx

ticagrelor + vardenafil

monitor ECG: combo may incr. vardenafil levels, risk of QT prolongation, cardiac arrhythmias, hypotension, priapism, other adverse effects (hepatic metabolism inhibited)

• venlafaxine
Brilinta (ticagrelor)

+

venlafaxine

1 interaction

Monitor/Modify Tx

ticagrelor + venlafaxine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• verapamil
Brilinta (ticagrelor)

+

verapamil

1 interaction

Monitor/Modify Tx

ticagrelor + verapamil

monitor HR: combo may incr. levels of both drugs, risk of dyspnea, bleeding, hypotension, PR interval prolongation, AV block, bradycardia, other adverse effects (hepatic metabolism inhibited, P-gp-mediated transport inhibited, additive effects)

• vilazodone
Brilinta (ticagrelor)

+

vilazodone

1 interaction

Monitor/Modify Tx

ticagrelor + vilazodone

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• vimseltinib
Brilinta (ticagrelor)

+

vimseltinib

1 interaction

Monitor/Modify Tx

ticagrelor + vimseltinib

give vimseltinib at least 4h before ticagrelor: combo may incr. ticagrelor levels, risk of dyspnea, bleeding, other adverse effects (P-gp-mediated transport inhibited)

• vinblastine
Brilinta (ticagrelor)

+

vinblastine

1 interaction

Monitor/Modify Tx

ticagrelor + vinblastine

monitor CBC: combo may incr. vinblastine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects; may decr. ticagrelor levels, efficacy (hepatic metabolism inhibited; hepatic metabolism induced)

• vincristine
Brilinta (ticagrelor)

+

vincristine

1 interaction

Monitor/Modify Tx

ticagrelor + vincristine

monitor CBC: combo may incr. vincristine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metabolism inhibited)

• vinorelbine
Brilinta (ticagrelor)

+

vinorelbine

1 interaction

Monitor/Modify Tx

ticagrelor + vinorelbine

monitor CBC: combo may incr. vinorelbine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metabolism inhibited)

• vinpocetine
Brilinta (ticagrelor)

+

vinpocetine

1 interaction

Monitor/Modify Tx

ticagrelor + vinpocetine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• vorapaxar
Brilinta (ticagrelor)

+

vorapaxar

1 interaction

Monitor/Modify Tx

ticagrelor + vorapaxar

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects)

• vortioxetine
Brilinta (ticagrelor)

+

vortioxetine

1 interaction

Monitor/Modify Tx

ticagrelor + vortioxetine

monitor bleeding s/sx: combo may incr. risk of bleeding, including life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

• warfarin
Brilinta (ticagrelor)

+

warfarin

1 interaction

Monitor/Modify Tx

ticagrelor + warfarin

monitor INR, bleeding s/sx, especially during initiation/titration: combo may incr. warfarin levels, risk of bleeding (including life-threatening), other adverse effects (hepatic metabolism inhibited, synergistic effects)

• willow bark
Brilinta (ticagrelor)

+

willow bark

1 interaction

Monitor/Modify Tx

ticagrelor + willow bark

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects, willow bark may contain salicylates)

• zanubrutinib
Brilinta (ticagrelor)

+

zanubrutinib

1 interaction

Monitor/Modify Tx

ticagrelor + zanubrutinib

monitor CBC, bleeding s/sx: combo may incr. zanubrutinib levels, risk of serious infection, myelosuppression, bleeding (including life-threatening), other adverse effects; may decr. ticagrelor levels, efficacy (hepatic metabolism inhibited, additive effects; hepatic metabolism induced)

• ziv-aflibercept
Brilinta (ticagrelor)

+

ziv-aflibercept

1 interaction

Monitor/Modify Tx

ticagrelor + ziv-aflibercept

monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, including life-threatening (additive effects)