Ticlopidine

What is Ticlopidine

Ticlopidine is an oral, platelet-aggregation inhibitor structurally related to clopidogrel.

Ticlopidine may be used as a second-line agent to prevent thromboembolism or stroke.

Rare cases of severe bone marrow toxicity limit ticlopidine’s use to patients who are intolerant or unresponsive to aspirin.

The use of ticlopidine has decreased with the availability of clopidogrel.

Clopidogrel is preferred to ticlopidine for the treatment of acute coronary syndromes (e.g., unstable angina or non-Q-wave MI, including patients undergoing PCI) due to its improved safety profile and shorter onset of action.

Ticlopidine has also been used for myocardial reinfarction prophylaxis; however, this is not an FDA-approved use. Ticlopidine was approved by the FDA in October 1991.

Brand Name

Ticlid

Indications

  1. acute myocardial infarction
  2. arterial thromboembolism prophylaxis
  3. claudication
  4. diabetic retinopathy
  5. myocardial infarction prophylaxis
  6. percutaneous coronary intervention (PCI)
  7. peripheral vascular disease (PVD)
  8. sickle cell disease
  9. stroke prophylaxis
  10. thrombosis prophylaxis
  11. transient ischemic attack
  12. unstable angina

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. anaphylactoid reactions
  4. angioedema
  5. anorexia
  6. aplastic anemia
  7. arthropathy
  8. asthenia
  9. cholestasis
  10. colitis
  11. diarrhea
  12. dizziness
  13. dyspepsia
  14. ecchymosis
  15. elevated hepatic enzymes
  16. eosinophilia
  17. epistaxis
  18. erythema multiforme
  19. exfoliative dermatitis
  20. flatulence
  21. GI bleeding
  22. headache
  23. hematuria
  24. hemolysis
  25. hemolytic anemia
  26. hepatic failure
  27. hepatic necrosis
  28. hepatitis
  29. hyperbilirubinemia
  30. hypercholesterolemia
  31. hypertriglyceridemia
  32. hyponatremia
  33. infection
  34. intracranial bleeding
  35. jaundice
  36. lupus-like symptoms
  37. maculopapular rash
  38. nausea
  39. nephrotic syndrome
  40. neutropenia
  41. new primary malignancy
  42. ocular hemorrhage
  43. pancytopenia
  44. peptic ulcer
  45. peripheral neuropathy
  46. platelet dysfunction
  47. pneumonitis
  48. prolonged bleeding time
  49. pruritus
  50. purpura
  51. rash
  52. renal failure (unspecified)
  53. serum sickness
  54. Stevens-Johnson syndrome
  55. thrombocytopenia
  56. thrombocytosis
  57. thrombotic thrombocytopenic purpura (TTP)
  58. tinnitus
  59. urticaria
  60. vasculitis
  61. vomiting

Monitoring Parameters

  • CBC
  • LFTs
  • platelet count

Contraindications

  • agranulocytosis
  • aplastic anemia
  • bleeding
  • bone marrow suppression
  • breast-feeding
  • coagulopathy
  • dental disease
  • dental work
  • geriatric
  • GI bleeding
  • hematological disease
  • hemophilia
  • hepatic disease
  • hypercholesterolemia
  • infection
  • intracranial bleeding
  • intramuscular injections
  • jaundice
  • labor
  • leukemia
  • neutropenia
  • obstetric delivery
  • peptic ulcer disease
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • retinal bleeding
  • surgery
  • thienopyridine hypersensitivity
  • thrombocytopenia
  • thrombotic thrombocytopenic purpura (TTP)
  • trauma

Interactions

  • Abciximab
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Ado-Trastuzumab emtansine
  • Altretamine
  • Aminolevulinic Acid
  • Anagrelide
  • Antacids
  • Antimetabolites
  • Antithrombin III
  • Antithymocyte Globulin
  • Apixaban
  • Argatroban
  • Arsenic Trioxide
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Betrixaban
  • Bexarotene
  • Bivalirudin
  • Bupivacaine; Lidocaine
  • Bupropion
  • Bupropion; Naltrexone
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Cannabidiol
  • Carbamazepine
  • Carisoprodol
  • Chlorambucil
  • Cilostazol
  • Cimetidine
  • Citalopram
  • Cladribine
  • Clobazam
  • Clofarabine
  • Clopidogrel
  • Collagenase
  • Cyclophosphamide
  • Cyclosporine
  • Dabigatran
  • Dalteparin
  • Danaparoid
  • Dasatinib
  • Defibrotide
  • Denileukin Diftitox
  • Desirudin
  • Desvenlafaxine
  • Digoxin
  • Dipyridamole
  • Doxercalciferol
  • Drotrecogin Alfa
  • Duloxetine
  • Edoxaban
  • Enoxaparin
  • Eptifibatide
  • Escitalopram
  • Esomeprazole
  • Esomeprazole; Naproxen
  • Estramustine
  • Ethotoin
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Fludarabine
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluvoxamine
  • Folate analogs
  • Fondaparinux
  • Fosphenytoin
  • Garlic, Allium sativum
  • Ginger, Zingiber officinale
  • Ginkgo, Ginkgo biloba
  • Green Tea
  • Heparin
  • Hydantoins
  • Ibritumomab Tiuxetan
  • Ibrutinib
  • Icosapent ethyl
  • Iloprost
  • Imatinib
  • Inotersen
  • Intravenous Lipid Emulsions
  • Lepirudin
  • Levomilnacipran
  • Lidocaine
  • Lidocaine; Prilocaine
  • Lomustine, CCNU
  • Loperamide
  • Loperamide; Simethicone
  • Mercaptopurine, 6-MP
  • Methoxsalen
  • Methylsulfonylmethane, MSM
  • Milnacipran
  • Mycophenolate
  • Nelarabine
  • Nonsteroidal antiinflammatory drugs
  • Obinutuzumab
  • Omeprazole; Sodium Bicarbonate
  • Paroxetine
  • Pegaspargase
  • Pentosan
  • Pentostatin
  • Pentoxifylline
  • Pexidartinib
  • Phentermine; Topiramate
  • Phenytoin
  • Photosensitizing agents (topical)
  • Platelet Glycoprotein IIb/IIIa Inhibitors
  • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
  • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
  • Purine analogs
  • Rasagiline
  • Riluzole
  • Rivaroxaban
  • Selumetinib
  • Sertraline
  • Sodium Bicarbonate
  • Sodium Hyaluronate, Hyaluronic Acid
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Sulfinpyrazone
  • Terbinafine
  • Theophylline, Aminophylline
  • Thioguanine, 6-TG
  • Thrombolytic Agents
  • Tinzaparin
  • Tipranavir
  • Tirofiban
  • Tizanidine
  • Tofacitinib
  • Topiramate
  • Trazodone
  • Treprostinil
  • Tretinoin, ATRA
  • Venlafaxine
  • Verteporfin
  • Vilazodone
  • Vorapaxar
  • Vorinostat
  • Vortioxetine
  • Warfarin
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