Drug Interaction Report

Ventricular pauses and bradycardia, mostly asymptomatic, have been observed in clinical studies with ticagrelor. Theoretically, the risk of symptomatic bradycardia may be increased during concomitant use of other agents known to induce bradycardia. However, in PLATO, a large, randomized, double-blind efficacy and safety comparison study with clopidogrel in patients with acute coronary syndromes, no evidence of clinically significant adverse interactions was observed during concomitant administration with one or more drugs known to induce bradycardia including beta-blockers (96%), the calcium channel blockers diltiazem and verapamil (33%), and digoxin (4%).

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.