Drug Interaction Report

MONITOR CLOSELY: The concomitant use of ticagrelor with other platelet inhibitors, anticoagulants, thrombolytic agents, or nonsteroidal anti-inflammatory drugs may increase the risk of bleeding, including severe and sometimes fatal hemorrhage.

MANAGEMENT: Caution is advised when these drugs are used concomitantly with ticagrelor or within 24 hours of ticagrelor dosing. Close clinical and laboratory observation for hemorrhagic complications is recommended. Patients should be advised to promptly report any signs of bleeding to their doctor, 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.

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.