Ticlopidine
TICLID
Pronunciation: tye-KLOE-pi-deen
“Tic Tic lid opened”
What it isIrreversible P2Y12 antagonist; the first thienopyridine.
Why this oneIt established P2Y12 blockade as an antiplatelet strategy, which clopidogrel then made practical.
What limits itNeutropenia and thrombotic thrombocytopenic purpura required frequent counts. Obsolete.
FDA-approved for
- stroke prevention (1991)
FDA label
Read the full label on DailyMed ↗
BOXED WARNING Life-threatening hematologic reactions: neutropenia/agranulocytosis, thrombotic thrombocytopenic purpura (TTP), and aplastic anemia; monitor hematologically and clinically during first 3 months; discontinue immediately if evidence occurs.
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Stroke (thrombotic) risk reduction | Adults | 250 mg BID | 250 mg BID | |
| Coronary artery stenting (adjunct with aspirin) | Adults | 250 mg BID | 250 mg BID up to 30 days |
Renal Undefined
Hepatic Contraindicated in severe hepatic impairment
Instructions
- Take with food
- For stenting, give together with antiplatelet doses of aspirin for up to 30 days post-implantation
Contraindications
- Hematopoietic disorders such as neutropenia and thrombocytopenia, or prior TTP or aplastic anemia
- Hemostatic disorder or active pathological bleeding (e.g., bleeding peptic ulcer, intracranial bleeding)
- Severe liver impairment
Cautions
- Neutropenia/agranulocytosis, TTP, aplastic anemia
- Increased bleeding risk
- GI complaints (diarrhea, nausea); rarely colitis
- Rash, including rare severe reactions (Stevens-Johnson, erythema multiforme)
Adverse reactions
- Diarrhea
- Nausea, dyspepsia
- Rash
- GI pain
- Neutropenia, purpura
Pregnancy No adequate human studies; use in pregnancy only if clearly needed (former category B)
Lactation Undefined
⚠ BOXED WARNINGS
- Neutropenia and agranulocytosis
- Thrombotic thrombocytopenic purpura
- Aplastic anemia
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityLife-threatening blood dyscrasias requiring early fortnightly monitoring
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