Generic Name

Ticlopidine Hydrochloride

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Classification

FDA Approved Indications

• Prevention of stroke in patients at risk for arterial thrombotic events

Mechanism of Action

Ticlopidine inhibits ADP-induced platelet aggregation by irreversibly blocking the P2Y12 receptor on platelets, thereby reducing thrombus formation.

Dosage and Administration

Adult: Initial dose: 250 mg twice daily. Dose may be adjusted based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; consider age-related renal and hepatic function.

Renal Impairment: Adjust dosage based on renal function.

Hepatic Impairment: Use with caution; hepatic function should be monitored.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed to body tissues.

Metabolism: Extensively metabolized in the liver via CYP450 enzymes.

Excretion: Primarily excreted in the urine and feces.

Half Life: Approximately 4-6 hours, but platelet inhibition lasts for life of platelet (~7-10 days).

Contraindications

• Active pathological bleeding (e.g., peptic ulcer, intracranial hemorrhage)

Precautions

• Use cautiously in patients with bleeding disorders, hepatic impairment, or recent surgery.

Adverse Reactions - Common

• Neutropenia (Less common)
• Diarrhea (Common)
• Dizziness (Common)

Adverse Reactions - Serious

• Thrombocytopenia or Bleeding (Rare but serious)
• Aplastic anemia (Very rare)
• Liver toxicity (Rare)

Drug-Drug Interactions

• Warfarin, other anticoagulants
• NSAIDs, aspirin

Drug-Food Interactions

• Alcohol may increase bleeding risk

Drug-Herb Interactions

• Ginger, ginkgo biloba, which may increase bleeding

Nursing Implications

Patient/Family Teaching

• Report signs of bleeding (bruising, bleeding gums, blood in stool or urine).
• Inform about increased bleeding risk with trauma or surgery.
• Avoid alcohol and NSAIDs unless directed by healthcare provider.

Special Considerations

Black Box Warnings:

• Potential for neutropenia and aplastic anemia, which may be sudden and severe.

Genetic Factors: CYP2C19 metabolism may affect individual responses.

Lab Test Interference: May cause abnormalities in blood counts, liver function tests.

Overdose Management

Signs/Symptoms: Excessive bleeding, bruising, gastrointestinal bleeding.

Treatment: Discontinue medication, provide supportive care, and treat bleeding symptoms. No specific antidote.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable for 2 years when stored properly.