Patients taking ticagrelor should also take a daily low maintenance dose of acetylsalicylic acid 75-100 mg, unless specifically contraindicated.
Acute coronary syndromes: Ticagrelor treatment should be initiated with a single 180 mg loading dose (two tablets of 90 mg) and then continued at 90 mg twice daily.
Missed dose: Lapses in therapy should also be avoided. A patient who misses a dose of ticagrelor should take only one tablet (their next dose) as its scheduled time.
Special populations: Elderly: No dose adjustment is required in elderly.
Renal impairment: No dose adjustment is necessary for patients with renal impairment. No information is available concerning treatment of patients on renal dialysis and therefore ticagrelor is not recommended in these patients.
Hepatic impairment: Ticagrelor has not been studied in patients with severe hepatic impairment and its use in these patients is therefore contraindicated. Only limited information is available in patients with moderate hepatic impairment. Dose adjustment is not recommended, but ticagrelor should be used with caution. No dose adjustment is necessary for patients with mild hepatic impairment.
Pediatric population: The safety and efficacy of ticagrelor in children below the age of 18 years have not been established. No data are available.
Method of administration: For oral use.
Ticagrelor can be administered with or without food.
For patients who are unable to swallow the tablets whole, the tablets can be crushed to a fine powder and mixed in half a glass of water and drunk immediately. The glass should be rinsed with a further half glass of water and the contents drunk. The mixture can also be administered via a nasogastric tube (CH8 or greater). It is important to flush the nasogastric tube through with water after administration of the mixture.