Ticlopidine HCl

A to Z Drug Facts

Ticlopidine HCl

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(tie-KLOE-pih-DEEN HIGH-droe-KLOR-ide)

Ticlid

Class: Antiplatelet

Action Produces time- and dose-dependent inhibition of both platelet aggregation and release of platelet granule constituents as well as prolongation of bleeding time; interferes with platelet membrane function by inhibiting platelet-fibrinogen binding and subsequent platelet-platelet interactions.

Indications Reduction of risk of thrombotic stroke in patients who have experienced stroke precursors and in patients who have had completed thrombotic stroke. Reserved for patients intolerant to aspirin because of greater risk of adverse reactions. Unlabeled use(s): Improved walking distance in intermittent claudication; vascular improvement in chronic arterial occlusion; reduced incidence of neurologic deficit in subarachnoid hemorrhage; reduced incidence of vascular occlusion in uremic patients with arteriovenous shunts or fistulas; control of platelet count in open heart surgery; decreased graft occlusion in coronary artery bypass grafts; reduced degree of proteinuria and hematuria in primary glomerulonephritis; educed incidence, duration and severity of infarctive crises in sickle cell disease.

Contraindications Presence of hematopoietic disorders (eg, neutropenia, thrombocytopenia); istory of thrombotic thrombocytopenic purpura (TTP); presence of hemostatic disorder or active pathologic bleeding (eg, bleeding, peptic ulcer, intracranial bleeding, hemophilia, other coagulation defects); severe liver impairment.

Route/Dosage

ADULTS: PO 250 mg bid with food.

Interactions

Antacids: May reduce ticlopidine absorption. Aspirin: Increased effect of aspirin on collagen-induced platelet aggregation. Cimetidine: Elevated ticlopidine levels with possible increase in therapeutic and toxic effects. Theophylline: Elevated serum theophylline concentrations, increasing risk of toxicity. Phenytoin: Elevated phenytoin plasma levels with associated somnolence and lethargy have been reported. Exercise caution when administering with ticlopidine.

Lab Test Interferences None well documented.

Adverse Reactions

CV: Vasculitis. CNS: Headache; peripheral neuropathy; dizziness. DERM: Maculopapular or urticarial rash; rash; pruritus. EENT: Tinnitus. GI: Diarrhea; nausea; fullness; dyspepsia; GI pain; purpura; vomiting; flatulence; norexia. GU: Nephrotic syndrome. HEMA: Prolonged bleeding time; bleeding complications (ecchymosis, epistaxis, hematuria, conjunctival hemorrhage, GI bleeding, perioperative bleeding); neutropenia; pancytopenia; hemolytic anemia; serum sickness; immune thrombocytopenia; abnormal liver function tests; TTP; agranulocytosis; eosinophilia; one marrow depression. HEPA: Hepatitis; cholestatic jaundice, increased alkaline phosphotase; erum transaminases and bilirubin. META: Increased cholesterol and triglycerides. OTHER: Weakness; pain; allergic pneumonitis; systemic lupus erythematosus; rthropathy; myositis; hyponatremia; aplastic anemia; hepatic necrosis; peptic ulcer; renal failure; sepsis; angioedema; hepatocellular jaundice.

Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy in children < 18 yr not established. Elderly patients: Require dosage reduction. Hematologic effects: Fatal reactions (eg, pancytopenia) have occurred. Life-threatening adverse reactions, including neutropenia/angranulocytosis and TTP can occur. Hypersensitivity: Reactions range from minor to life-threatening. Liver disease: Use not recommended because patient may have pre-existing bleeding diathesis. Renal impairment: Dosage reduction or discontinuation of therapy may be required if hemorrhagic or hematopoietic complications occur. Neutropenia: Neutropenia may occur suddenly.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer medication with food.
Anticoagulant or fibrinolytic drugs must be discontinued before initiation of ticlopidine administration.
Ticlopidine must be discontinued 10–14 days before surgery.
Store at room temperature.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies. Note ulcers and bleeding problems.
Monitor patients for evidence of neutropenia or TTP. Immediately discontinue ticlopidine if there is any evidence of neutropenia or TTP.
Ensure that patient does not have pre-existing bleeding tendency by monitoring PT/PTT. Measure periodically during therapy.
Check results of CBC with platelets and ANC (absolute neutrophil count); check platelet count and the appearance of the peripheral smear.
Take vital signs including orthostatic BP and pulse.
Assess for signs of infection.
Obtain CBC with platelets and ANC as baseline and then every 2 wk during first 3 mo of therapy. Assess more frequently if ANC decreases constantly or is 30% less than baseline. After 3 mo, if CBC, platelet and ANC are stable, assess these values only if there are signs of infection or bleeding.
When drug is discontinued, perform CBC with platelet and ANC 1–3 wk after last dose.
Monitor LFTs periodically during therapy.
Monitor for nausea, vomiting or diarrhea.
Monitor for signs of bleeding, including petechiae or unusual bruising.

OVERDOSAGE: SIGNS & SYMPTOMS
	Increased bleeding time, increased ALT

Patient/Family Education

Instruct patient to take with food.
Inform patient of increased risk of bleeding and caution patient to take precautionary measures (eg, not to use manual razor, to use soft toothbrush, to handle knives carefully, to always wear shoes when walking).
Instruct patient to report signs of infection (eg, fever, white overgrowth in mouth, vaginal yeast, nonhealing wounds or wounds that appear red with drainage) to physician.
Advise patient to notify physician of signs of blood or changes in stool or urine, unusual bruising, decreased appetite, dark urine, light-colored stools or yellow skin color.
Instruct patient to inform physicians and dentist of drug regimen before undergoing any treatments or surgery or receiving new drugs.
Suggest that patient carry identification (eg, Medi-Alert) indicating drug regimen and condition.
Advise patient to separate administration of ticlopidine and antacids by at least 2 hr.
Advise patients to immediately report symptoms and signs of TTP (g, fever, weakness, difficulty speaking, seizures, yellowing of skin or eyes, dark or bloody urine, pallor, or pinpoint hemorrhagic spots on the skin).