Ticlopidine (HCl)

Ticlopidine (HCl) reduces platelet aggregation. Ticlopidine (HCl) acts by producing changes (may be irreversible) to the platelet membrane reducing their ability to form blood clots with fibrin. It is used in combination with other antiplatelet drugs to reduce the risk of further thrombolytic events. It particularly useful in patients who cannot tolerate aspirin.

Ticlopidine (HCl) is primarily indicated in conditions like Stroke, Coronary Artery Stent Thrombosis and Prevention.

Ticlopidine (HCl) is contraindicated in conditions like Thrombocytopenia, GI ulceration, Bleeding, Leukopenia, Agranulocytosis, Hemorrhagic diathesis.

Adverse reactions in stroke patients were relatively frequent with over 50% of patients reporting at least one. Most (30% to 40%) involved the gastrointestinal tract. Most adverse effects are mild, but 21% of patients discontinued therapy because of an adverse event, principally diarrhea, rash, nausea, vomiting, GI pain and neutropenia. Most adverse effects occur early in the course of treatment, but a new onset of adverse effects can occur after several months. The incidence rates of adverse events listed in the following table were derived from multicenter, controlled clinical trials in stroke patients described above comparing ticlopidine, placebo and aspirin over study periods of up to 5.8 years. Adverse events considered by the investigator to be probably drug-related that occurred in at least 1% of patients treated with ticlopidine are shown in the following table: Incidence of discontinuation, regardless of relationship to therapy, is shown in parentheses.

Ticlopidine should be used with extreme caution in patients with history of bleeding disorder, ulcers, liver problems or low blood count. It should be used with caution during pregnancy or lactation.

Drug should not be given to Pregnant Mothers. If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

250 mg (250 (250)) 12 hourly PO — With meals. Scraped Dose — One case of deliberate overdosage with ticlopidine has been reported by a foreign postmarketing surveillance program. A 38-year-old male took a single 6000-mg dose of ticlopidine (equivalent to 24 standard 250-mg tablets). The only abnormalities reported were increased bleeding time and increased SGPT. No special therapy was instituted and the patient recovered without sequelae. Single oral doses of ticlopidine at 1600 mg/kg and 500 mg/kg were lethal to rats and mice, respectively. Symptoms of acute toxicity were GI hemorrhage, convulsions, hypothermia, dyspnea, loss of equilibrium and abnormal gait.

( ) — Not recommended in this age group

( ) — Not recommended in this age group

Therapeutic doses of ticlopidine caused a 30% increase in the plasma half-life of antipyrine and may cause analogous effects on similarly metabolized drugs. Therefore, the dose of drugs metabolized by hepatic microsomal enzymes with low therapeutic ratios or being given to patients with hepatic impairment may require adjustment to maintain optimal therapeutic blood levels when starting or stopping concomitant therapy with ticlopidine. Studies of specific drug interactions yielded the following results:

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