Ticlopidine Side Effects
Medically reviewed by Drugs.com. Last updated on Apr 9, 2023.
Applies to ticlopidine: oral tablet.
Oral route (Tablet)
Ticlopidine can cause life-threatening hematological adverse reactions, including neutropenia/agranulocytosis, thrombotic thrombocytopenic purpura (TTP) and aplastic anemia. Hematological adverse reactions cannot be reliably predicted by any identified demographic or clinical characteristics. During the first 3 months of treatment, patients receiving ticlopidine must, therefore, be hematologically and clinically monitored for evidence of neutropenia or TTP. If any such evidence is seen, ticlopidine should be immediately discontinued.
Serious side effects of Ticlopidine
Along with its needed effects, ticlopidine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking ticlopidine:
Less common or rare
- Abdominal or stomach pain (severe) or swelling
- back pain
- blistering, peeling, or loosening of the skin or lips or mucous membranes (moist lining of many body cavities, including the mouth, lips, inside of nose, anus, and vagina)
- blood in eyes
- bloody or black tarry stools
- bruising or purple areas on skin
- change in mental status
- convulsions (seizures)
- coughing up blood
- dark or bloody urine
- decreased alertness
- fever, chills, or sore throat
- headache (severe or continuing)
- joint pain or swelling
- pale color of skin
- paralysis or problems with coordination
- pinpoint red spots on skin
- red lesions on the skin, often with a purple center
- red, thickened, or scaly skin
- sores, ulcers, or white spots in mouth
- stammering or other difficulty in speaking
- unusually heavy bleeding or oozing from cuts or wounds
- unusual tiredness
- unusually heavy or unexpected menstrual bleeding
- vomiting of blood or material that looks like coffee grounds
- yellow eyes or skin
Check with your doctor as soon as possible if any of the following side effects occur while taking ticlopidine:
- Skin rash
Less common or rare
- General feeling of discomfort or illness
- hives or itching of skin
- ringing or buzzing in ears
Other side effects of Ticlopidine
Some side effects of ticlopidine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Abdominal or stomach pain (mild)
- Bloating or gas
For Healthcare Professionals
Applies to ticlopidine: oral tablet.
The majority of cases of neutropenia, agranulocytosis, aplastic anemia, and thrombotic thrombocytopenic purpura occur during the first three months of treatment. US physicians reported 100 cases of TTP between 1992 and 1997. Delayed onset of neutropenia, after discontinuation of ticlopidine, has been reported. Hematologic parameters should be monitored every other week for the first three months of therapy and ticlopidine should be discontinued if laboratory values are altered or if symptoms of infection or bleeding are noted. Thereafter, the patient should be monitored for signs of infection. Patients should be counseled concerning signs and symptoms of TTP (weakness, pallor, petechiae, purpura, dark urine, jaundice or mental status changes) and instructed to discontinue ticlopidine and immediately report any of these findings. Platelet infusions may accelerate thrombosis and should be avoided if possible.
Ecchymosis, epistaxis, hematuria, conjunctival hemorrhage, and gastrointestinal bleeding have been associated with ticlopidine therapy. Intracerebral bleeding occurred in approximately 0.5% of patients in clinical trials.
Postsurgical bleeding may also occur. To minimize the effects of postsurgical bleeding, it is generally recommended that ticlopidine be discontinued 2 weeks before any surgical or dental interventions.[Ref]
Hematologic dyscrasias have been the most serious adverse effects associated with ticlopidine therapy. Reversible neutropenia (severe in 0.9%) occurred in 2.4% of patients. Thrombocytopenia, agranulocytosis, pancytopenia, hemolytic anemia with reticulocytosis, and aplastic anemia have been reported.
Thrombotic thrombocytopenic purpura (TTP), not noted during clinical trials, has occurred at an estimated incidence of 1 case per 2000 to 4000 exposures. Symptoms include thrombocytopenia, microangiopathic hemolytic anemia (fragmented RBCs on a peripheral smear), renal dysfunction, fever, and neurological changes.[Ref]
Gastrointestinal disturbances have been noted in up to 40% of patients. Dyspepsia, nausea, diarrhea, vomiting, flatulence, and gastric pain have occurred. Some gastrointestinal symptoms lessen with continued therapy and administration with food may decrease gastrointestinal intolerance. Cases of ticlopidine-induced chronic diarrhea have been reported.[Ref]
Two case reports of patients developing maculopapular pruritic rashes following administration of clopidogrel have been reported. The rash recurred in both patients after switching to ticlopidine. In one patient, rechallenge resulted in recurrence of the rash. These two cases illustrate the possibility of cross-sensitivity between thienopyridines.[Ref]
Dermatologic adverse effects have occurred frequently. Rash, generally maculopapular or urticarial, has been experienced in up to 15% of treated patients. At least one case of multiple fixed-drug eruptions, consisting of rash and generalized patches of hyperpigmentation, has been reported.[Ref]
Cholestatic jaundice has developed within 1 to 4 months of initiating therapy. Resolution of jaundice and normalization of hepatic enzymes concentrations occurred upon discontinuation of therapy.
Numerous cases of ticlopidine-induced cholestatic hepatitis have been reported. Time to the onset of hepatotoxicity is variable and ranges from 1 week to 6 months after initiating ticlopidine, 2 to 12 weeks in most patients. In one patient, hepatotoxicity appeared 1 month after discontinuing ticlopidine because of rash. Symptoms and liver abnormalities resolved following discontinuation of ticlopidine, typically within 1 to 3 months; however, recovery time may be protracted (i.e. more than 12 months). Cases of irreversible hepatic damage have not been reported.[Ref]
Hepatic side effects typically have been mild and have included reversible elevations in liver function tests (up to 4%). The incidence of cholestatic jaundice has increased. Postmarketing side effects have included hepatitis and hepatic necrosis.[Ref]
Metabolic disturbances have included persistent elevation of total serum cholesterol.[Ref]
Side effects have occurred in up to 50% of patients. Generally, side effects have been mild and most frequently involved the gastrointestinal tract (30% to 40%). Diarrhea, rash, nausea, vomiting, gastric pain, and neutropenia were the primary cause of a 21% discontinuation rate. Asthenia and generalized pain have been reported.[Ref]
Postmarketing hypersensitivity reactions have included allergic pneumonitis, angioedema, vasculitis, and serum sickness. Several cases of ticlopidine-induced systemic and cutaneous lupus erythematosus (positive ANA) have been reported. Clinical improvement occurred in all patients following withdrawal of ticlopidine.[Ref]
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Some side effects may not be reported. You may report them to the FDA.