Aspirin with Ticlopidine Interaction Details

Brand Names Associated with Aspirin

Brand Names Associated with Ticlopidine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Mar 04, 2024

Interaction Effect

An increased risk of bleeding

Interaction Summary

Aspirin, an antiplatelet agent[1], and ticlopidine, a platelet aggregation inhibitor, may increase the risk of bleeding when coadministered. Therefore concomitant use is not recommended as ticlopidine may potentiate the effects of aspirin [2]. Although in one study, with the concomitant administration of ticlopidine (250 mg to 750 mg daily) and aspirin (1500 mg daily), ticlopidine enhanced the inhibition of collagen-induced platelet aggregation by aspirin. In contrast, aspirin had no effect on the inhibition of adenosine diphosphate-induced platelet aggregation by ticlopidine [3]. Monitoring of bleeding may be warranted if coadministration is required.

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

The concurrent use of aspirin, an antiplatelet agent[1], and ticlopidine, a platelet aggregation inhibitor, is not recommended as ticlopidine may potentiate the effects of aspirin [2] resulting in an increased risk of bleeding [1]. If concomitant cannot be avoided, close monitoring of signs and symptoms of bleeding may be warranted.

Mechanism Of Interaction

Additive inhibition of platelet aggregation

Literature Reports

A) The Intracoronary Stenting and Antithrombotic Regimen (ISAR) trial established the efficacy of combined treatment with aspirin and ticlopidine, which is now the mainstay of antithrombotic prophylactics after coronary stent placement. Multiple large studies have showed that neutropenia is rare in the first four weeks of therapy. However, neutropenia peaked at two and three months of combined therapy with ticlopidine and aspirin. The recommendation is to not withhold ticlopidine therapy after stenting. However, it is recommended to monitor regular blood counts [4].

B) One group of researchers reports that there may be a higher incidence of neutropenia than reported in patients on ticlopidine plus aspirin. It is recommended to regularly monitor blood counts even during short term therapy with ticlopidine. Because ticlopidine has such a long half-life, monitoring should continue one week after discontinuation of therapy [5].

C) Four studies demonstrated a low subacute thrombosis rate with antiplatelet therapy without implementation of anticoagulant therapy. However, in three of these trials, conflicting results were reported regarding the relative efficacy of various antiplatelet therapies. Limitations of these studies included non-randomization and poorly-designed studies. The American College of Chest Physicians (ACCP) and the American College of Cardiology (ACC) recommend the use of ticlopidine and aspirin only in low risk patients [6].

References

1 ) Product Information: AGGRENOX(R) oral extended release capsules, aspirin dipyridamole oral extended release capsules. Boehringer Ingelheim Pharmaceuticals, Inc. (per FDA), Ridgefield, CT, 2012.

2 ) Product Information: ticlopidine HCl oral film coated tablets, ticlopidine HCl oral film coated tablets. Sandoz Inc (per DailyMed), Princeton, NJ, 2008.

3 ) Thebault JJ, Blatrix CE, Blanchard JF, et al: The interactions of ticlopidine and aspirin in normal subjects. J Int Med Res 1977; 5:405-411.

4 ) Neumann FJ, Hall D, & Schomig A: Neutropenia with ticlopidine plus aspirin (letter). Lancet 1997; 349:1552-1553.

5 ) Haushofer A, Halbmayer WM, & Prachar H: Neutropenia with ticlopidine plus aspirin (letter). Lancet 1997; 349:474-475.

6 ) Hobson AG & Sowinski KM: Ticlopidine and aspirin therapy following implantation of coronary artery stents. Ann Pharmacother 1997; 31:770-772.

Aspirin Overview

• Prescription aspirin is used to relieve the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), osteoarthritis (arthritis caused by breakdown of the lining of the joints), systemic lupus erythematosus (condition in which the immune system attacks the joints and organs and causes pain and swelling) and certain other rheumatologic conditions (conditions in which the immune system attacks parts of the body). Nonprescription aspirin is used to reduce fever and to relieve mild to moderate pain from headaches, menstrual periods, arthritis, toothaches, and muscle aches. Nonprescription aspirin is also used to prevent heart attacks in people who have had a heart attack in the past or who have angina (chest pain that occurs when the heart does not get enough oxygen). Nonprescription aspirin is also used to reduce the risk of death in people who are experiencing or who have recently experienced a heart attack. Nonprescription aspirin is also used to prevent ischemic strokes (strokes that occur when a blood clot blocks the flow of blood to the brain) or mini-strokes (strokes that occur when the flow of blood to the brain is blocked for a short time) in people who have had this type of stroke or mini-stroke in the past. Aspirin will not prevent hemorrhagic strokes (strokes caused by bleeding in the brain). Aspirin is in a group of medications called salicylates. It works by stopping the production of certain natural substances that cause fever, pain, swelling, and blood clots.

• Aspirin is also available in combination with other medications such as antacids, pain relievers, and cough and cold medications. This monograph only includes information about the use of aspirin alone. If you are taking a combination product, read the information on the package or prescription label or ask your doctor or pharmacist for more information.

Ticlopidine Overview

• Ticlopidine is used to reduce the risk of stroke in people who have had a stroke or have had warning signs of a stroke and who cannot be treated with aspirin. Ticlopidine is also used along with aspirin to prevent blood clots from forming in coronary stents (metal tubes surgically placed in clogged blood vessels to improve blood flow). It works by preventing platelets (a type of blood cell) from collecting and forming clots.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.