Ticagrelor with Dabigatran Etexilate Interaction Details
Brand Names Associated with Ticagrelor
- Brilinta®
- Ticagrelor
Brand Names Associated with Dabigatran Etexilate
- Dabigatran
- Pradaxa®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Increased dabigatran exposure
Interaction Summary
Coadministration of dabigatran, a p-glycoprotein (P-gp) substrate, and ticagrelor, a P-gp inhibitor, may result in increased dabigatran exposure, particularly in patients with renal impairment. No dose adjustment is recommended for dabigatran when coadministered with ticagrelor; however, concomitant use should be avoided in patients with severe renal impairment (CrCl, 15 to 30 mL/min). Concomitant use should also be avoided if the patient is receiving treatment for recurrent DVT and pulmonary embolism and CrCl less than 50 mL/min.
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
The concomitant use of dabigatran and ticagrelor may result in increased dabigatran exposure, particularly in patients with renal impairment. No dose adjustment is recommended for dabigatran when coadministered with ticagrelor; however, concomitant use should be avoided in patients with severe renal impairment (CrCl, 15 to 30 mL/min). Concomitant use should also be avoided if the patient is receiving treatment for recurrent DVT and pulmonary embolism and CrCl less than 50 mL/min.
Mechanism Of Interaction
Inhibition of P-glycoprotein-mediated efflux transport of dabigatran
Literature Reports
A) A drug interaction study demonstrated that coadministration of dabigatran 110 mg twice daily with ticagrelor 90 mg twice daily increased the AUC and Cmax of dabigatran by 26% and 29%, respectively, while coadministration with a loading dose of ticagrelor 180 mg, the levels increased by 49% and 65%, respectively. However, ticagrelor 180 mg loading dose when given 2 hours after dabigatran only increased the AUC and Cmax of dabigatran by 27% and 24%, respectively .
Ticagrelor Overview
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Ticagrelor is used to prevent a serious or life-threatening heart attack or stroke, or death in people who have had a heart attack or who have acute coronary syndrome (ACS; blockage of blood flow to the heart). It is also used to prevent blood clots from forming in people who have received coronary stents (metal tubes surgically placed in clogged blood vessels to improve blood flow) to treat ACS. Ticagrelor is used to decrease the risk of a first-time heart attack or stroke in people at risk with coronary artery disease (CAD; reduced blood flow to the heart). It is also used to decrease the risk of another more serious stroke in people who are having a mild to moderate stroke or a transient ischemic attack (TIA; ministroke). Ticagrelor is in a class of medications called antiplatelet medications. It works by preventing platelets (a type of blood cell) from collecting and forming clots that may cause a heart attack or stroke.
Dabigatran Etexilate Overview
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Dabigatran is used to treat deep vein thrombosis (DVT; a blood clot, usually in the leg) and pulmonary embolism (PE; a blood clot in the lung) in adults and children 3 months of age and older who have been treated with an injectable anticoagulant ('blood thinner'). It is also used to reduce the risk of a DVT and PE from happening again after initial treatment is completed in adults and children 3 months of age and older. Dabigatran is used to help prevent DVT and PE in adults who have had hip replacement surgery. Dabigatran is also used to help prevent strokes or serious blood clots in adults who have atrial fibrillation (a condition in which the heart beats irregularly, increasing the chance of clots forming in the body, and possibly causing strokes) without heart valve disease. Dabigatran is in a class of anticoagulant medications called direct thrombin inhibitors. It works by preventing blood clots from forming in the body.
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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:
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.