Brilinta pills 90 mg 56 pcs
Condition: New product
1000 Items
Rating:
Be the first to write a review!
More info
Active ingredients
Ticagrelor
Release form
Pills
Composition
1 tab .: Ticagrelor 90 mg. Adjuvants: mannitol - 126 mg, calcium hydrophosphate - 63 mg, carboxymethyl starch sodium - 9 mg, hyprolosis - 9 mg, magnesium stearate - 3 mg. Composition of film coating: hypromellose 2910 - 5.6 mg, titanium dioxide (E171) - 1.7 mg, talc - 1 mg, macrogol 400 - 0.6 mg, iron dye yellow oxide (E172) - 0.1 mg.
Pharmacological effect
Antiplatelet drug. The mechanism of action of Brillinta contains ticagrelor, a member of the chemical class of cyclopentyl triazolopyrimidines, which is a selective and reversible antagonist of direct-acting P2Y12 receptors and prevents ADP-mediated P2Y12-dependent activation and platelet aggregation. Ticagrelor does not prevent the binding of ADP, but its interaction with the P2Y12-platelet receptor prevents ADP-induced signal transduction. Since platelets are involved in the initiation and / or development of thrombotic complications of atherosclerosis, it has been shown that inhibition of platelet function reduces the risk of cardiovascular events, such as death, myocardial infarction, or stroke. endogenous equilibrium nucleoside transporter (ENT-1). Adenosine is formed locally in places of hypoxia and tissue damage by release from ATP and DF. Ticagrelor inhibits ENT-1 and prolongs T1 / 2 adenosine, thereby increasing its local extracellular concentration, enhancing the local adenosine response. Ticagrelor has no clinically significant direct effect on adenosine receptors (A1, A2A, A2B, A3) and is not metabolized to adenosine. Adenosine has the following effects, which include: vasodilation, cardioprotection, inhibition of platelet aggregation, modulation of inflammation and the occurrence of dyspnea, which can affect the clinical profile of ticagrelor. In healthy volunteers and in patients with acute coronary syndrome (ACS), ticagrelor enhanced the following effects of adenosine: vasodilation (estimated as an increase in coronary blood flow in healthy volunteers; headache), inhibition of platelet function (in vitro in whole human blood) and shortness of breath.However, the association of elevated local concentrations of adenosine with clinical outcomes (morbidity and mortality rates) has not been proven. The onset of action in patients with a stable course of coronary artery disease with acetylsalicylic acid has begun to act quickly, as confirmed by the results of determining the average inhibition of platelet aggregation (IAT) : after 0.5 h after taking ticagrelor at a loading dose of 180 mg, the average IAT value is approximately 41%, the maximum IAT value of 89% is reached after 2- 4 hours after taking the drug and maintained for 2–8 hours. In 90% of patients, the final IAT value of more than 70% is reached 2 hours after taking the drug. Termination When planning coronary artery bypass surgery (CABG), the risk of bleeding increases if ticagrelor stops using less than 96 hours before the procedure. Data on switching from one drug to another. Switching from clopidogrel to ticagrelor leads to an increase in the absolute value of IAT by 26.4%, and a change in therapy from ticagrelor to clopidogrel leads to a decrease in absolute The values IAT 24.5%. It is possible to change the therapy with clopidogrel to ticagrelor without interrupting antithrombotic effekta.Klinicheskaya effektivnostV study PLATO (PLATelet Inhibition and Patient Outcomes - Inhibition of platelet and outcomes of patients), there were 18,624 patients in whom the last 24 hours had developed symptoms of unstable angina, myocardial infarction without lifting ST segment or myocardial infarction with ST segment elevation and who were treated conservatively, or by percutaneous coronary intervention (CKB), or CABG. In this study, with daily treatment with acetylsalicylic acid ticagrelor 90 mg 2 times / day was compared with clopidogrel 75 mg / day for efficacy in preventing the development of a combined endpoint of cardiovascular death, myocardial infarction or stroke due to the effect on the frequency of cardiovascular deaths and myocardial infarction. The loading dose was 300 mg of clopidogrel (a dose of 600 mg was also allowed during PCI) or 180 mg of ticagrelor. The effect of ticagrelor manifested itself early (on the 30th day the absolute risk decreased / ATS / by 0.6% and the relative risk decreased / COP / by 12%), maintaining a constant effect of therapy for 12 months,Brillint reduces the relative risk of a combined endpoint (a combination of cardiovascular deaths, heart attack and stroke) in patients with unstable angina, myocardial infarction without ST elevation and myocardial infarction. a 16% increase in the ST segment (hazard ratio / RR / 0.84; 95% confidence interval / DI / 0.77–0.92; p = 0.0003), cardiovascular death by 21% (RR 0.79; 95% CI 0.69–0.91; p = 0.0013), myocardial infarction by 16% (RR 0.84; 95% CI 0.75–0.95; p = 0.0045). The effectiveness of the Brillinta preparation is shown in various patient groups, regardless of body weight, gender, diabetes history, transient ischemic attack or non-hemorrhagic stroke, revascularization, concomitant therapy (including heparin, glycoprotein IIb / IIIa inhibitors, final diagnosis (myocardial infarction without ST elevation, myocardial infarction, STI, myocardial infarction) with ST segment elevation and unstable angina) and treatment scheduled for randomization (invasive or conservative). Additional analysis suggested a possible link with oh acetylsalicylic acid; this was expressed in the fact that reduced efficacy was observed when taking Brilint's drug in combination with acetylsalicylic acid in high doses. The recommended dose of acetylsalicylic acid for continuous use in combination with Brillinta is 75-150 mg. While studying Brillinta, statistically significant COP is shown by the cumulative criterion: death from cardiovascular causes, myocardial infarction and stroke in patients with acute coronary syndrome, who Invasive intervention is planned (COP 16%, SAR 1.7%, p = 0.0025). In a search analysis of the effectiveness of Brilin's drug, COP was also shown at the primary end point in patients with acute coronary syndrome who were prescribed conservative therapy (COP 15%, CAP 2.3%, nominal p = 0.0444). In patients after stenting, a decrease in the incidence of stent thrombosis was observed (СОР 32%, САР 0.6%, nominal р = 0.0123). Brillinta preparation caused statistically significant СОР by 16% (САР 2.1%) by such cumulative criterion as death from all causes , myocardial infarction and stroke. The death from all causes on taking Brilint's drug was 22% at a nominal level of significance p = 0.0003 and CAP - 1.4%. The aggregate criterion of the combined efficacy and safety The aggregate criterion of the combined efficacy and safety (death cardiovascular causes, myocardial infarction,stroke or major bleeding as defined by PLATO) confirms that within 12 months after acute coronary syndrome the positive effect of ticagrelor is not neutralized by cases of major bleeding (COP 8%, SAR 1.4%, RR 0.92; p = 0.0257).
Pharmacokinetics
Ticagrelor is characterized by linear pharmacokinetics; Exposure of ticagrelor and active metabolite (AR-C124910XX) is approximately proportional to dose up to 1260 mg. Absorption Ticagrelor is rapidly absorbed with an average Tmax value of approximately 1.5 hours. The formation of the main metabolite AR-C124910XX circulating in the blood (also active) from ticagrelor occurs quickly with an average Tmax approximately 2.5 hours. After taking a fasting dose of ticagrelor at a dose of 90 mg Cmax is 529 ng / ml, AUC - 3451 ng × h / ml. The average absolute bioavailability of ticagrelor is 36%. Eating fat does not affect the Cmax of ticagrelor or the AUC of the active metabolite, but results in an increase of 21% in the AUC of ticagrelor and a decrease of 22% in the Cmax of the active metabolite. These small changes have minimal clinical significance; therefore, ticagrelor can be administered regardless of food intake. Ticagrelor in the form of a suspension of crushed pills in drinking water taken orally or introduced into the stomach through a nasogastric probe is bioequivalent to ticagrelor orally ingested as Brillinta pills (AUC and Cmax ticagrelor and active metabolite in the range 80-125%.) In the case of receiving the suspension, the initial exposure (after 0.5 h and 1 h after ingestion) was higher than when taking ticagrelor in the form of Brillinta pills, but later (from 2 h to 48 h) the profile tions was practically odinakovym.RaspredelenieSvyazyvanie ticagrelor with plasma proteins and its active metabolite high (> 99%). The equilibrium Vd of ticagrelor is 87.5 l. Metabolism CYP3A4 is the main isoenzyme responsible for the metabolism of ticagrelor and the formation of an active metabolite, and their interaction with other CYP3A substrates varies from activation to inhibition. Ticagrelor and the active metabolite are weak inhibitors of P-glycoprotein (P-gp). The main metabolite of ticagrelor is AR-C124910XX, which is also active, which is confirmed by the results of the evaluation of binding to the P2Y12 ADP-platelet receptor in vitro. Systemic exposure of the active metabolite is approximately 30-40% of the exposure to ticagrelor. Introduction The main route of ticagrelor excretion is through hepatic metabolism.With the introduction of the isotope-labeled ticagrelor, on average, approximately 57.8% of the radioactivity is excreted with feces, 26.5% with urine. The excretion of ticagrelor and the active metabolite in the urine is less than 1% of the dose. In general, the active metabolite is excreted in the bile. The average T1 / 2 of ticagrelor and active metabolite was 7 and 8.5 hours, respectively. The pharmacokinetics in special clinical situations in elderly patients (75 years and older) showed a higher exposure of ticagrelor (Cmax and AUC by about 25% higher) and active metabolite compared to young patients. These differences are not considered clinically significant. There are no data on the use of ticagrelor in children. Women have a higher exposure to ticagrelor and an active metabolite than men. These differences are not considered clinically significant. The average bioavailability of the drug in Asian patients is 39% higher than in Caucasians. The bioavailability of Brillinta is 18% lower in patients of the Negroid race compared with Caucasians. The ticagrelor exposure is about 20% lower and the active metabolite is about 17% higher in patients with severe renal failure (CC <30 ml / min) compared with patients with normal renal function. Cmax and AUC of ticagrelor were 12% and 23% higher in patients with mild hepatic insufficiency compared with healthy volunteers. Ticagrelor has not been studied in patients with moderate or severe hepatic insufficiency; therefore, the use of the drug in this category of patients is contraindicated.
Indications
In combination with acetylsalicylic acid: - for the prevention of atherothrombotic complications in patients with acute coronary syndrome (unstable angina, myocardial infarction without ST elevation or ST myocardial infarction [STEMI]), including patients who received drug therapy, and patients exposed percutaneous coronary intervention or coronary artery bypass surgery.
Contraindications
- hypersensitivity to ticagrelor or any of the components of the drug; - active pathological bleeding; - history of intracranial hemorrhage; - moderate or severe hepatic failure; - combined use of ticagrelor with powerful CYP3A4 inhibitors (for example, ketoconazole,clarithromycin, nefazodone, ritonavir and atazanavir) - children and adolescents under 18 years old (due to lack of data on the efficacy and safety of use in this group of patients). With caution, use the drug in patients with a predisposition to bleeding due to recent injury, recent surgery, bleeding disorders, active or recent gastrointestinal bleeding); in patients with concomitant therapy with drugs that increase the risk of bleeding (ie, NSAIDs, oral anticoagulants and / or fibrinolytics) for 24 hours before taking Brillinta; in patients with an increased risk of developing bradycardia (for example, patients with SSS without a pacemaker, with AV block II or III; fainting associated with bradycardia) due to insufficient experience with the clinical use of Brillinta; together with drugs that cause bradycardia; in patients with asthma and COPD (if a patient reports a new episode of dyspnea, prolonged dyspnea or worsening dyspnea, an examination should be conducted, and in case of intolerance, treatment with ticagrelor should be stopped). therefore, it is necessary to evaluate renal function in accordance with routine clinical practice, paying particular attention to patients aged 75 years and older, patients with renal weeks sufficiently moderate and severe, patients receiving receptor antagonists angiotenzina.Neobhodima caution in patients with hyperuricaemia or gouty arthritis in history. As a preventive measure, the use of ticagrelor in patients with hyperuricemic nephropathy should be avoided. The combined use of ticagrelor and acetylsalicylic acid in a high maintenance dose (more than 300 mg) is not recommended. clinical indications also for ECG and blood levels of digoxin). There is no data on the combined use of ticagrelor with powerful inhibitors of P-glycoprotein (for example, verapamil and quinidine), therefore simultaneous therapy with these drugs should be carried out with caution.
Precautionary measures
Do not exceed recommended doses.
Use during pregnancy and lactation
Data on the use of the drug Brilinta in pregnant women are missing or limited. Brilin's drug is not recommended for use during pregnancy. As the risk for the newborn / infant cannot be ruled out, Brillinta is not recommended during breastfeeding. In experimental animal studies, ticagrelor caused a slight decrease in mother's weight gain, reduced vitality of the newborn and his body weight, growth retardation. Available pharmacodynamic, toxicological data in animals have shown that ticagrelor and its active metabolites are excreted in breast milk.
Dosage and administration
The drug is taken orally, regardless of the meal. The use of Brillinta should be started with a single loading dose of 180 mg (2 tab. 90 mg) and then continue taking 90 mg 2 times / day. For patients with difficulty swallowing the pill (or 2 pills - in the case of receiving a loading dose, grind to the state of a fine powder, mix in 1/2 cup of drinking water and immediately drink the resulting suspension. Mix the rest with an additional 1/2 cup of drinking water and drink the resulting suspension. A suspension can also be administered via a nasogastric tube (CH8 or larger). After the introduction of the suspension, it is necessary to rinse the nasogastric tube with water in order to completely dose the patient’s stomach. At the same time, in the absence of specific contraindications, acetylsalicylic acid is prescribed (from 75 mg to 150 mg with a constant dose) daily. Avoid interruptions in therapy. In case of missing a dose of Brillinta, the patient should take only one 90 mg tablet (next dose) at the scheduled time. If necessary, patients taking clopidogrel can be transferred to taking Brillinta. It is recommended to conduct Brillin therapy for 12 months, except in cases of clinical need for early withdrawal of the drug. Data on the use of ticagrelor for more than 12 months is limited. In patients with acute coronary syndrome, early cancellation of any antiplatelet therapy, including Brillinta, may increase the risk of cardiovascular death or myocardial infarction as a result of the underlying disease.Premature discontinuation of the drug should be avoided. Patients of advanced age do not require dose adjustment. Patients with renal insufficiency do not require dose adjustment of the drug. There is no information about the use of Brillinta in patients on hemodialysis, so its use in these patients is not indicated. Patients with mild hepatic insufficiency do not require dose adjustment. There was no study of Brillinta in patients with moderate or severe hepatic insufficiency, therefore, use in this category of patients is contraindicated. The safety and efficacy of Brillinta in children and adolescents under the age of 18, according to the indication approved in adults, has not been established.
Side effects
According to the PLATO study, the most frequent adverse reactions reported in patients receiving ticagrelor were shortness of breath, bruises and nosebleeds.
Overdose
Ticagrelor is well tolerated with a single dose of the drug up to 900 mg. Symptoms: in a single study with an increase in dose, the adverse effect on the gastrointestinal tract was dose-limiting. Other clinically significant adverse reactions that may have occurred during an overdose were dyspnea and ventricular pauses. Due to the inhibition of platelets, an increase in the duration of bleeding is a presumed pharmacological effect in overdosing with Brillinta. Treatment: monitor clinical symptoms and an ECG. Ticagrelor is not excreted by hemodialysis, the antidote is not known. Symptomatic therapy should be carried out in accordance with accepted standards. With the development of bleeding is necessary to carry out appropriate supportive measures.
Interaction with other drugs
Effects of other drugs on Brilinta drug Medicines that are metabolized by the CYP3A4 isoenzyme CYP3A4 inhibitors. Powerful inhibitors of CYP3A4: combined use of ketoconazole with ticagrelor increases Cmax and AUC of ticagrelor 2.4 and 7.3 times, respectively. Cmax and AUC of the active metabolite are reduced by 89% and 56%, respectively. Other potent inhibitors of CYP3A4 (clarithromycin, nefazodone, ritonavir, and atazanavir) will have the same effects, so their combined use with Brillinta is contraindicated. Moderate CYP3A4 inhibitors: combined use of diltiazem with ticagrelor increases Cx ticagrelore by 69%, a AUC, at the same time, it reduces the Cmax of the active metabolite by 38%, and the AUC does not change.Ticagrelor does not affect diltiazem plasma concentrations. Other moderate inhibitors of CYP3A4 (for example, amprenavir, aprepitant, erythromycin, fluconazole) can be administered simultaneously with the Brillinta preparation. Cyclosporine (an inhibitor of P-gp and CYP3A4). The combined use of cyclosporine (at a dose of 600 mg) with ticagrelor increases the Cmax and AUC of ticagrelor 2.3 and 2.8 times, respectively. At the same time, there is an increase in the AUC of the active metabolite by 32% and a decrease in Cmax by 15%. Ticagrelor does not affect the plasma concentration of cyclosporine. CYP3A4 inducers. The combined use of rifampicin with ticagrelor reduces Cmax and AUC of ticagrelor by 73% and 86%, respectively. The maximal active metabolite does not change, and the AUC decreases by 46%. Other inducers of CYP3A4 (for example, phenytoin, carbamazepine, and phenobarbital) are likely to decrease the exposure of Brilint's drug. Powerful inducers of CYP3A4 can reduce the exposure and effectiveness of Brilint's drug. Other drugs. According to the results of pharmacological studies of the interaction, the concomitant use of ticagrelor with heparin, enoxaparin and acetylsalicylic acid or desmopressin does not affect the pharmacokinetics of ticagrelor, its active metabolite, and ADP-dependent platelet aggregation. If there are clinical indications for prescribing drugs that affect hemostasis, they should be used with caution in combination with Brillinta. There are no data on the joint use of Brillinta with powerful inhibitors of P-glycoprotein (for example, verapamil and quinidine) that can increase the exposure of ticagrelor . If combined use cannot be avoided, then the combination therapy should be carried out with caution. Cmax and AUC of simvastatinic acid increase by 64% and 52%, respectively, at the same time, in some cases, these indicators increase by 2-3 times. The combined use of simvastatin in a dose above 40 mg / day with ticagrelor can lead to the development of side effects of simvastatin. Therefore, if necessary, this combination should assess the ratio of the potential risk and benefits of therapy.Combined use of Brillinta with simvastatin and lovastatin in a dose of over 40 mg is not recommended. Atorvastatin: concomitant use of atorvastatin and ticagrelor increases Cmax and AUC of atorvastatin acid metabolites by 23% and 36%, respectively. A similar increase in Cmax and AUC values is observed for all atorvastatinic acid metabolites. These changes are not considered clinically significant. Similar effects with statins metabolized by CYP3A4 cannot be excluded. In the PLATO study, 93% of patients in the group receiving ticagrelor and various statins did not experience any unwanted signs regarding the safety of statins. Ticagrelor is a moderate CYP3A4 inhibitor. Combined use of Brillinta and CYP3A4 substrates with a narrow therapeutic index (for example, cisapride or ergot alkaloids) is not recommended, because ticagrelor may increase the exposure of these drugs. Drugs that are metabolized by the CYP2C9 isoenzyme With the simultaneous use of ticagrelor and tolbutamide, the plasma concentrations of none of these drugs have changed. This suggests that ticagrelor is not an inhibitor of the CYP2C9 isoenzyme, and it is unlikely that it affects the CYP2C9 mediated metabolism of drugs like warfarin and tolbutamide. affects the pharmacokinetics of levonorgestrel. No clinically significant effect on contraceptive efficacy is expected with simultaneous use of levonorgestrel, ethinyl estradiol and Brillinta. P-gp substrate (including digoxin and cyclosporine) The concomitant use of digoxin with ticagrelor increases Cmax and AUC of digoxin by 75% and 28%, respectively. When taken together with ticagrelor, on average Cmin of digoxin increased by 30%, in some cases by 2 times. Cax and AUC of ticagrelor did not change when using digoxin. Therefore, it is recommended to conduct appropriate clinical and / or laboratory monitoring with simultaneous use of Brillint and P-gp-dependent drugs with a narrow therapeutic index, like digoxin and cyclosporine. Other concomitant therapies. When using Brillinta together with drugs that can cause bradycardia, care should be taken.However, in the PLATO study, no clinically significant adverse events were observed when combined with one or more drugs that can cause bradycardia (eg, 96% are beta-blockers, 33% are calcium antagonists, including diltiazem and verapamil, and 4% are digoxin). In the PLATO study, Brillinta was predominantly prescribed together with acetylsalicylic acid, proton pump inhibitors, statins, beta-blockers, ACE inhibitors and angiotensin receptor antagonists as part of long-term administration, as well as with heparin ohm, low molecular weight heparins, glycoprotein IIb / IIIa receptor inhibitors for iv administration as part of short-term therapy. According to the results of these studies, no clinically significant undesirable interaction was detected. The combined use of Brillinta with heparin, enoxaparin or desmopressin did not affect the APTT, activated clotting time (ABC) and the study of factor Xa, however, due to the potential pharmacodynamic interaction, caution is required when using it together with drugs that affect hemostasis. In connection with reports of subcutaneous hemorrhages against the background of the use of selective inhibitor a serotonin reuptake (e.g., paroxetine, citalopram and sertraline), it is advisable to be careful when coadministered with the drug Brilinta.Pri daily use of grapefruit juice in large volumes (200 ml 3 times / day) it was observed a twofold increase ticagrelor exposure. It is expected that such an increase in ticagrelor exposure has no clinical significance for most patients.
special instructions
Risk of bleeding development In patients with acute coronary syndrome who received Brillint therapy and acetylsalicylic acid, there was an increased risk of not having major bleeding from CABG and hemorrhages requiring increased medical attention, such as major bleeding + minor bleeding as defined by PLATO, but the risk of lethal / life-threatening bleeding. When prescribing Brillinta, the ratio of the benefits of prophylaxis of atherothrombotic events and risk in patients with elevated If there is clinical evidence, Brillinta should be used with caution in the following groups of patients: - Patients' susceptibility to bleeding (for example, due to a recent injury, a recent operation,bleeding disorders, active or recent bleeding from the gastrointestinal tract). Brilin's use is contraindicated in patients with active pathological bleeding, history of intracranial hemorrhage, moderate or severe hepatic insufficiency - concomitant use of drugs that can increase the risk of bleeding (for example, NSAIDs, oral anticoagulants and / or fibrinolytics taken within 24 hours before taking Brilint). There are no data on the hemostatic efficiency of platelet transfusions when using Brillinta; Brilinta can inhibit transfused platelets in the blood. Since with the concomitant use of Brillinta and desmopressin, the standardized bleeding time did not decrease, it is unlikely that desmopressin will effectively stop the bleeding. Antifibrinolytic therapy (aminocaproic acid or tranexamic acid) and / or recombinant factor Vlla can increase hemostasis. After determining the cause of bleeding and stopping it, you can resume Brillinta therapy. Surgery Before a scheduled operation or the start of taking new drugs, the patient must inform the doctor about Brillin. In patients undergoing CABG, the incidence of major bleeding with Brilin was the same as with the use of clopidogrel on all days after discontinuation of therapy, except day 1, when the incidence of major bleeding was higher when taking Bree Inta. If a patient undergoes a planned operation and the antithrombotic effect is not desirable, then Brillinta therapy should be discontinued 7 days before the operation. Patients at risk of developing bradycardia. Due to the discovery of generally asymptomatic pauses, patients with an increased risk of developing bradycardia (for example, patients without a pacemaker diagnosed with SSS, AV-blockade of the heart of grade II or III; syncope associated with bradycardia) were not included in the main study to assess Key to the safety and efficacy of Brillinta. Therefore, due to the limited clinical experience of using the drug in these patients, it is recommended that Brillinta be prescribed to such patients with caution. Additional caution is necessary when using Brillinta together with drugs that can cause bradycardia.However, there were no clinically significant side effects when combined with one or more drugs that can cause bradycardia (for example, 96% beta-blockers, 33% calcium channel blockers, including diltiazem and verapamil, and 4% digoxin). using daily ECG Holter monitoring in the ticagrelor group compared with clopidogrel, more patients in the acute phase of acute coronary syndrome (ACS) had ventricular pauses> 3 seconds. The increase in the number of ventricular pauses recorded by daily monitoring of Holter, while receiving ticagrelor was observed more often in patients with chronic heart failure compared with the general population in the acute phase of ACS, but not in the first month. The pauses in these patients were not accompanied by subsequent undesirable clinical consequences (fainting and installation of a pacemaker). Shortness of breath Shortness of breath when using Brillinta is usually weak or moderate in intensity, often disappearing as the treatment continues. Patients with bronchial asthma / COPD may have an increased absolute risk of shortness of breath when taking Brillinta. In patients with asthma / COPD, ticagrelor should be used with caution. The mechanism of dyspnea when taking ticagrelor is not clear. If a patient has developed a new episode of dyspnea, dyspnea persists or during the use of Brillint, then a complete examination is necessary, and in case of intolerance, the drug should be stopped. The mechanism of this effect is not known. Assessment of renal function should be made one month after the start of the drug, and subsequently in accordance with routine clinical practice, paying particular attention to patients aged 75 years and older, patients with moderate or severe renal insufficiency and receiving angiotensin receptor antagonists therapy. uric acid levels in patients receiving ticagrelor have a higher risk of hyperuricemia than taking clopidogrel. Care must be taken in patients with a history of hyperuricemia or gouty arthritis.As a preventative measure