Drug Interaction Report

CONTRAINDICATED: Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of ticagrelor, which is primarily metabolized by the isoenzyme. In healthy volunteers, administration of ticagrelor in combination with the potent CYP450 3A4 inhibitor ketoconazole resulted in increased ticagrelor peak plasma concentration (Cmax) and systemic exposure (AUC) by 2.4-fold and 7.3-fold, respectively, and reduced Cmax and AUC of the active metabolite by 89% and 56%, respectively.

MANAGEMENT: Concomitant use of ticagrelor with potent CYP450 3A4 inhibitors is considered contraindicated by some foreign authorities. The U.S. labeling for ticagrelor recommends avoiding use with potent CYP450 3A4 inhibitors. Labeling for itraconazole, a potent CYP450 3A4 inhibitor, specifically contraindicates use with ticagrelor during and for 2 weeks after treatment with itraconazole.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.