Drug Interaction Report

MONITOR: Prostacyclin/prostacyclin analogs (e.g., epoprostenol, iloprost, treprostinil) inhibit platelet aggregation and may theoretically potentiate the risk of bleeding in patients treated with other agents that affect hemostasis such as anticoagulants, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or agents that commonly cause thrombocytopenia. In clinical trials for pulmonary hypertension, patients received concomitant anticoagulants and/or nonsteroidal anti-inflammatory agents without evidence of increased bleeding.

MANAGEMENT: Caution is advised if prostacyclin and prostacyclin analogs are used in combination with other drugs that affect hemostasis. Close clinical and laboratory observation for hemorrhagic complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

ADJUST DOSING INTERVAL: The bioavailability and gastrointestinal tolerance of ticlopidine is enhanced by food.

MANAGEMENT: Patients may be advised to take ticlopidine with meals.