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Ticlopidine (United States: Not available): Drug information

Ticlopidine (United States: Not available): Drug information
(For additional information see "Ticlopidine (United States: Not available): Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Hematologic toxicity:

Ticlopidine HCl can cause life-threatening hematological adverse reactions, including neutropenia/agranulocytosis and thrombotic thrombocytopenic purpura (TTP) and aplastic anemia.

Neutropenia/agranulocytosis:

Among 2048 patients in clinical trials, there were 50 cases (2.4%) of neutropenia (less than 1200 neutrophils/mm3), and the neutrophil count was below 450/mm3 in 17 of these patients (0.8% of the total population).

TTP:

One case of TTP was reported during clinical trials. Based on postmarketing data, US physicians reported about 100 cases between 1992 and 1997. Based on an estimated patient exposure of 2 million to 4 million, and assuming an event reporting rate of 10% (the true rate is not known), the incidence of ticlopidine-associated TTP may be as high as 1 case in every 2000 to 4000 patients exposed.

Aplastic anemia:

Aplastic anemia was not seen during clinical trials in stroke patients, but US physicians reported about 50 cases between 1992 and 1998. Based on an estimated patient exposure of 2 million to 4 million, and assuming an event reporting rate of 10% (the true rate is not known), the incidence of ticlopidine-associated aplastic anemia may be as high as 1 case in every 4000 to 8000 patients exposed.

Monitoring of clinical and hematologic status:

Severe hematologic adverse reactions may occur within a few days of the start of therapy. The incidence of TTP peaks after about 3 to 4 weeks of therapy and neutropenia peaks at approximately 4 to 6 weeks. The incidence of aplastic anemia peaks after about 4 to 8 weeks of therapy. The incidence of the hematologic adverse reactions declines thereafter. Only a few cases of neutropenia, TTP, or aplastic anemia have arisen after more than 3 months of treatment.

Hematological adverse reactions cannot be reliably predicted by any identified demographic or clinical characteristics. During the first 3 months of treatment, patients receiving ticlopidine HCl must, therefore, be hematologically and clinically monitored for evidence of neutropenia or TTP. If any such evidence is seen, ticlopidine HCl should be immediately discontinued.

Brand Names: Canada
  • Apo-Ticlopidine
Pharmacologic Category
  • Antiplatelet Agent;
  • Antiplatelet Agent, Thienopyridine;
  • P2Y12 Antagonist
Dosing: Adult

Note: Ticlopidine is no longer available in the United States.

Stroke prevention

Stroke prevention: Oral: 250 mg twice daily.

Note: Overall, the use of ticlopidine is no longer recommended for this indication and has largely been replaced by clopidogrel (Ref).

Dosing: Kidney Impairment: Adult

There are no dosage adjustment provided in the manufacturer's labeling. While there were no statistically significant differences in ADP-induced platelet aggregation, AUC increases and clearance decreases were seen in patients with mild to moderate renal impairment. However, bleeding time may be prolonged in patients with moderate renal impairment

Hemodialysis: Not dialyzable (Ref).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustment provided in the manufacturer's labeling. Use with caution. Use is contraindicated in severe hepatic impairment.

Dosing: Older Adult

Oral: 250 mg twice daily with food; dosage in older patients has not been determined; however, in two large clinical trials, the average age of subjects was 63 and 66 years. A dosage decrease may be necessary if bleeding occurs.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. As with all drugs which may affect hemostasis, bleeding is associated with ticlopidine. Hemorrhage may occur at virtually any site. Risk is dependent on multiple variables, including the use of multiple agents which alter hemostasis and patient susceptibility.

>10%:

Endocrine & metabolic: Hyperlipidemia (8% to 10%; within 1 month of therapy), increased serum triglycerides

Gastrointestinal: Diarrhea (13%; may be chronic)

1% to 10%:

Central nervous system: Dizziness (1%)

Dermatologic: Skin rash (5%), pruritus (1%)

Gastrointestinal: Dyspepsia (7%), nausea (7%), gastrointestinal pain (4%), flatulence (2%), vomiting (2%), anorexia (1%)

Hematologic & oncologic: Neutropenia (2%), purpura (2%)

Hepatic: Increased serum alkaline phosphatase (>2 x upper limit of normal: 8%), abnormal hepatic function tests (1%)

<1%, postmarketing, and/or case reports: Agranulocytosis, anaphylaxis, angioedema, aplastic anemia, arthropathy, bone marrow depression, bronchiolitis obliterans organizing pneumonia, conjunctival hemorrhage, ecchymosis, eosinophilia, epistaxis, erythema multiforme, erythema nodosum, exfoliative dermatitis, gastrointestinal hemorrhage, headache, hematuria, hemolytic anemia, hepatic necrosis, hepatitis, hypermenorrhea, hypersensitivity pneumonitis, hyponatremia, increased serum bilirubin, intracranial hemorrhage, immune thrombocytopenia, increased serum creatinine, jaundice, maculopapular rash, myositis, nephrotic syndrome, pain, pancytopenia, peptic ulcer, peripheral neuropathy, positive ANA titer, renal failure, sepsis, serum sickness, Stevens-Johnson syndrome, systemic lupus erythematosus, thrombocythemia, thrombotic thrombocytopenic purpura (TTP), tinnitus, urticaria, vasculitis, weakness

Contraindications

Hypersensitivity to ticlopidine or any component of the formulation; active pathological bleeding such as peptic ulcer bleeding or intracranial hemorrhage; severe liver impairment; hematopoietic disorders (neutropenia, thrombocytopenia, or a past history of TTP or aplastic anemia); hemostatic disorders

Warnings/Precautions

Concerns related to adverse effects:

• Hematologic toxicity: [US Boxed Warning]: May cause life-threatening hematologic reactions, including neutropenia, agranulocytosis, thrombotic thrombocytopenic purpura (TTP), and aplastic anemia. Routine monitoring is required (see Monitoring Parameters). Monitor for signs and symptoms of neutropenia including WBC count. Discontinue if the absolute neutrophil count falls to <1,200/mm3 or if laboratory signs of TTP or aplastic anemia occur.

• Thienopyridine hypersensitivity: Because of structural similarities, cross-reactivity is possible among the thienopyridines (clopidogrel, prasugrel, and ticlopidine); use with caution or avoid in patients with previous thienopyridine hypersensitivity. Use of ticlopidine is contraindicated in patients with hypersensitivity to ticlopidine.

Disease-related concerns:

• Bleeding disorders: Use with caution in patients with platelet disorders, bleeding disorders and/or at increased risk for bleeding (eg, PUD, trauma, or surgery).

• Hepatic impairment: Use with caution in patients with mild-to-moderate hepatic impairment. Use is contraindicated with severe hepatic impairment.

• Renal impairment: Use with caution in patients with moderate-to-severe renal impairment (experience is limited); bleeding times may be significantly prolonged and the risk of hematologic adverse events (eg, neutropenia) may be increased.

Concurrent drug therapy issues:

• Anticoagulants and platelet aggregation inhibitors: Use with caution in patients receiving either anticoagulants (eg, heparin, warfarin) or other platelet aggregation inhibitors; bleeding risk is increased.

Special populations:

• Lower GI bleed patients: An individualized and multidisciplinary approach should be utilized to determine therapy discontinuation and management in patients with acute lower GI bleed (LGIB) who are on antiplatelet medications; risk of ongoing bleeding should be weighed with risk of thromboembolic events. In patients receiving dual antiplatelet therapy (aspirin plus P2Y12 receptor blocker [eg, clopidogrel, prasugrel, ticagrelor, ticlopidine]) or thienopyridine monotherapy, the thienopyridine should generally be resumed as soon as possible and at least within 7 days, taking into account control of bleeding and cardiovascular risk (aspirin should not be discontinued); however, dual antiplatelet therapy should not be discontinued in the 90 days post-acute coronary syndrome or 30 days post-coronary stenting (Strate 2016).

Other warnings/precautions:

• Coronary artery stents: In patients who have received bare-metal or drug-eluting stents (sirolimus or paclitaxel), premature interruption of antiplatelet therapy may result in stent thrombosis with subsequent fatal and nonfatal myocardial infarction. If ticlopidine is used, duration of therapy, in general, is determined by the type of stent placed (bare metal or drug eluting) and whether an ACS event was ongoing at the time of placement (Levine, 2011).

• Elective surgery: Consider discontinuing 10 to 14 days before elective surgery (except in patients with cardiac stents that have not completed their full course of dual antiplatelet therapy; patient-specific situations need to be discussed with cardiologist; AHA/ACC/SCAI/ACS/ADA Science Advisory provides recommendations).

Product Availability

Ticlopidine is no longer available in the US.

Pricing: US

Tablets (Ticlopidine HCl Oral)

250 mg (60): $111.97

Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer of the brand and/or generic product, respectively. The pricing data should be used for benchmarking purposes only, and as such should not be used to set or adjudicate any prices for reimbursement or purchasing functions. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Tablet, Oral, as hydrochloride:

Generic: 250 mg

Administration: Adult

Administer with food.

Use: Labeled Indications

Platelet aggregation inhibitor that reduces the risk of thrombotic stroke in patients who have had a stroke or stroke precursors (Note: Due to its association with life-threatening hematologic disorders, ticlopidine should be reserved for patients who are intolerant to aspirin, who have failed aspirin therapy, or who are not eligible to receive other antiplatelet therapy.)

Medication Safety Issues
Older Adult: High-Risk Medication:

Pharmacy Quality Alliance (PQA): Ticlopidine is identified as a high-risk medication in patients 65 years and older on the PQA’s, Use of High-Risk Medications in the Elderly (HRM) performance measure, a safety measure used by the Centers for Medicare and Medicaid Services (CMS) for Medicare plans (PQA 2017).

Metabolism/Transport Effects

Inhibits CYP1A2 (weak), CYP2B6 (weak), CYP2C19 (weak), CYP2D6 (weak)

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Abrocitinib: Agents with Antiplatelet Properties may enhance the antiplatelet effect of Abrocitinib. Management: Do not use antiplatelet drugs with abrocitinib during the first 3 months of abrocitinib therapy. The abrocitinib prescribing information lists this combination as contraindicated. This does not apply to low dose aspirin (81 mg/day or less). Risk X: Avoid combination

Acalabrutinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): May enhance the antiplatelet effect of other Agents with Antiplatelet Properties. Risk C: Monitor therapy

Anagrelide: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Anticoagulants: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Risk C: Monitor therapy

Apixaban: Antiplatelet Agents (P2Y12 Inhibitors) may enhance the adverse/toxic effect of Apixaban. Specifically, the risk for bleeding may be increased. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor. Risk D: Consider therapy modification

Bemiparin: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

BuPROPion: CYP2B6 Inhibitors (Weak) may increase the serum concentration of BuPROPion. Risk C: Monitor therapy

Caplacizumab: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Caplacizumab. Specifically, the risk of bleeding may be increased. Management: Avoid coadministration of caplacizumab with antiplatelets if possible. If coadministration is required, monitor closely for signs and symptoms of bleeding. Interrupt use of caplacizumab if clinically significant bleeding occurs. Risk D: Consider therapy modification

Cephalothin: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased. Risk C: Monitor therapy

Cilostazol: Ticlopidine may increase serum concentrations of the active metabolite(s) of Cilostazol. Ticlopidine may increase the serum concentration of Cilostazol. Risk C: Monitor therapy

CloBAZam: CYP2C19 Inhibitors (Weak) may increase serum concentrations of the active metabolite(s) of CloBAZam. CYP2C19 Inhibitors (Weak) may increase the serum concentration of CloBAZam. Risk C: Monitor therapy

CloZAPine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of CloZAPine. Risk C: Monitor therapy

Collagenase (Systemic): Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and or bleeding may be increased. Risk C: Monitor therapy

CycloSPORINE (Systemic): Ticlopidine may decrease the serum concentration of CycloSPORINE (Systemic). Risk C: Monitor therapy

Dabigatran Etexilate: Antiplatelet Agents (P2Y12 Inhibitors) may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Antiplatelet Agents (P2Y12 Inhibitors) may increase the serum concentration of Dabigatran Etexilate. Specifically, clopidogrel may increase dabigatran serum concentrations. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor. Risk D: Consider therapy modification

Dasatinib: May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Deoxycholic Acid: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased. Risk C: Monitor therapy

Diamorphine: May diminish the antiplatelet effect of Antiplatelet Agents (P2Y12 Inhibitors). Diamorphine may decrease the serum concentration of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor therapy

Edoxaban: Antiplatelet Agents (P2Y12 Inhibitors) may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Management: Carefully consider the anticipated risks and benefits of this combination. If combined, increased monitoring for bleeding is recommended. Risk D: Consider therapy modification

Enoxaparin: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding. Risk D: Consider therapy modification

FentaNYL: May diminish the antiplatelet effect of Antiplatelet Agents (P2Y12 Inhibitors). FentaNYL may decrease the serum concentration of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor therapy

Fezolinetant: CYP1A2 Inhibitors (Weak) may increase the serum concentration of Fezolinetant. Risk X: Avoid combination

Fosphenytoin-Phenytoin: CYP2C19 Inhibitors (Weak) may increase the serum concentration of Fosphenytoin-Phenytoin. Risk C: Monitor therapy

Heparin: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required. Risk D: Consider therapy modification

Herbal Products with Anticoagulant/Antiplatelet Effects (eg, Alfalfa, Anise, Bilberry): May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Risk C: Monitor therapy

Ibritumomab Tiuxetan: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding. Risk C: Monitor therapy

Ibrutinib: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Icosapent Ethyl: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Inotersen: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Ketamine: Ticlopidine may increase the serum concentration of Ketamine. Risk C: Monitor therapy

Lecanemab: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of hemorrhage may be increased. Risk C: Monitor therapy

Limaprost: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Lipid Emulsion (Fish Oil Based): May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Mavacamten: CYP2C19 Inhibitors (Weak) may increase the serum concentration of Mavacamten. Management: Start mavacamten at 5 mg/day if stable on a weak CYP2C19 inhibitor. For those stable on mavacamten who are initiating a weak CYP2C19 inhibitor, reduce mavacamten dose by one dose level. Risk D: Consider therapy modification

Morphine (Systemic): May diminish the antiplatelet effect of Antiplatelet Agents (P2Y12 Inhibitors). Morphine (Systemic) may decrease the serum concentration of Antiplatelet Agents (P2Y12 Inhibitors). Management: Consider alternative anti-ischemic/analgesic therapies (eg, beta-blockers, nitroglycerin) in patients with acute coronary syndromes treated with a P2Y12 inhibitor when possible. The risks associated with other opioids are unknown. Risk D: Consider therapy modification

Multivitamins/Fluoride (with ADE): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Multivitamins/Minerals (with AE, No Iron): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Obinutuzumab: Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased. Risk C: Monitor therapy

Omega-3 Fatty Acids: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Pentosan Polysulfate Sodium: May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents. Risk C: Monitor therapy

Pentoxifylline: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Pirtobrutinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Rivaroxaban: Antiplatelet Agents (P2Y12 Inhibitors) may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor. Risk D: Consider therapy modification

Selective Serotonin Reuptake Inhibitors: May enhance the antiplatelet effect of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor therapy

Selumetinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the antiplatelet effect of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor therapy

Sibutramine: CYP2B6 Inhibitors (Weak) may increase serum concentrations of the active metabolite(s) of Sibutramine. CYP2B6 Inhibitors (Weak) may increase the serum concentration of Sibutramine. Risk C: Monitor therapy

Theophylline Derivatives: CYP1A2 Inhibitors (Weak) may increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy

Thioridazine: CYP2D6 Inhibitors (Weak) may increase the serum concentration of Thioridazine. Management: Consider avoiding concomitant use of thioridazine and weak CYP2D6 inhibitors. If combined, monitor closely for QTc interval prolongation and arrhythmias. Some weak CYP2D6 inhibitors list use with thioridazine as a contraindication. Risk D: Consider therapy modification

Thrombolytic Agents: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents. Risk C: Monitor therapy

Tipranavir: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

TiZANidine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use is necessary, initiate tizanidine at an adult dose of 2 mg and increase in 2 to 4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Risk D: Consider therapy modification

Urokinase: Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase. Risk X: Avoid combination

Vitamin E (Systemic): May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Zanubrutinib: May enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy

Food Interactions

Ticlopidine bioavailability may be increased (20%) if taken with food. High-fat meals increase absorption, antacids decrease absorption. May cause upset stomach. Management: Take with food to reduce stomach upset.

Pregnancy Considerations

Teratogenic effects have not been observed in animal reproduction studies. Information related to ticlopidine use in a pregnant woman has been noted in a case report (Ueno 2001).

Breastfeeding Considerations

It is not known if ticlopidine is excreted in breast milk. Due to the potential for serious adverse reactions in the nursing infant, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother.

Monitoring Parameters

Signs of bleeding; CBC with differential at baseline prior to treatment initiation and then weekly for the first 3 months of therapy; more frequent monitoring is recommended for patients whose absolute neutrophil counts have been consistently declining or are 30% less than baseline values. The peak incidence of TTP occurs between 3-4 weeks, the peak incidence of neutropenia occurs at approximately 4-6 weeks, and the incidence of aplastic anemia peaks after 4-8 weeks of therapy. Few cases have been reported after 3 months of treatment. Liver function tests (alkaline phosphatase and transaminases) should be performed in the first 4 months of therapy if liver dysfunction is suspected.

Mechanism of Action

Ticlopidine requires in vivo biotransformation to an unidentified active metabolite. This active metabolite irreversibly blocks the P2Y12 component of ADP receptors, which prevents activation of the GPIIb/IIIa receptor complex, thereby reducing platelet aggregation. Platelets blocked by ticlopidine are affected for the remainder of their lifespan.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: ~6 hours

Peak effect: 3-5 days; serum levels do not correlate with clinical antiplatelet activity

Absorption: Well absorbed

Protein binding: Parent drug: 98%; <15% bound to alpha1-acid glycoprotein

Metabolism: Extensively hepatic; has at least 1 active metabolite

Half-life elimination: 13 hours

Time to peak, serum: ~2 hours

Excretion: Urine (60%); feces (23%)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: Average plasma concentration is slightly higher in cirrhosis.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Ticlid;
  • (AR) Argentina: Dosier | Ticlid | Ticlopidina quesada | Trombenal;
  • (AT) Austria: Thrombodine | Ticlopidin | Tiklid;
  • (AU) Australia: Ticlid | Ticlopidine hexal | Tilodene;
  • (BD) Bangladesh: Ticlopid;
  • (BE) Belgium: Ticlid | Ticlopidine eurogenerics | Ticlopidine ratiopharm | Ticlopidine teva generics belgium;
  • (BG) Bulgaria: Aclotin | Tagren | Ticlid | Ticlopid;
  • (BR) Brazil: Cloridrato de ticlopidina | Desagreg | Plaketar | Plavasc | Ticlid | Ticlobal;
  • (CH) Switzerland: Ticlid;
  • (CL) Chile: Ateroclar | Ticlid;
  • (CN) China: Declot | Mai le | Qi luo | Tai lu da | Tian xin li bo | Tianxin-libo | Ticlid | Ticlopidine | You pu rong;
  • (CO) Colombia: Ticlid | Ticlodone | Ticlopid | Ticlopidina | Ticlosyn;
  • (CZ) Czech Republic: Aclotin | Apo tic | Ipaton | Tagren | Ticlid | Ticlopidin;
  • (DE) Germany: Desitic | Ticlo biochemie | Ticlo Puren | Ticlopidin | Ticlopidin al | Ticlopidin beta | Ticlopidin CT | Ticlopidin Ratiopharm | Ticlopidin Sandoz | Ticlopidin stada | Ticlopidina Ratiopharm | Tiklid | Tiklyd;
  • (DO) Dominican Republic: Antiplak | Desplaq | Lipozil | Tarclox | Ticlid | Ticlodin | Ticlofran | Ticlopidina Cinfa | Ticlopidina genfar | Ticlosyn;
  • (EC) Ecuador: Ticlid | Ticlopidina | Ticlosyn;
  • (EE) Estonia: Tagren | Ticlid | Ticlopidin Ratiopharm;
  • (EG) Egypt: Ticlid | Ticlopide;
  • (ES) Spain: Ticlodone | Ticlopidina alter | Ticlopidina bayvit | Ticlopidina Cinfa | Ticlopidina merck | Ticlopidina normon | Ticlopidina qualix | Ticlopidina Ranbaxy | Ticlopidina Ratiopharm | Ticlopidina rubio | Ticlopidina ur | Tiklid;
  • (FR) France: Ticlid | Ticlopidine arrow | Ticlopidine EG | Ticlopidine g gam | Ticlopidine merck | Ticlopidine Qualimed | Ticlopidine Sandoz;
  • (GB) United Kingdom: Ticlid;
  • (GR) Greece: Etfariol | Neo omnipen | Ticlid | Ticlodone;
  • (HK) Hong Kong: Aplaket | Apo-Ticlopidine | Ticlid | Tipidin;
  • (HR) Croatia: Tagren | Tiklopidin;
  • (HU) Hungary: Aclotin | Aplatic | Ipaton | Placor | Ticlid | Ticlogal | Ticlopidin Hexal;
  • (ID) Indonesia: Agulan | Antrotik | Cartrilet | Goclid | Nufaclapide | Piclodin | Ticard | Ticlid | Ticlon | Ticlophar | Ticuring;
  • (IE) Ireland: Ticlid;
  • (IL) Israel: Ticlidil | Ticlopidine Teva;
  • (IN) India: Aplaket | Blothin | Rheovas | Ticlantin | Ticlobest | Ticlogard | Ticlop | Ticlopid | Ticlovas | Ticlovil | Tikla | Tikleen | Tilcon | Tyklid;
  • (IT) Italy: Anagregal | Antigreg | Aplaket | Chiaro | Clox | Fluilast | Flupid | Fluxidin | Klodin | Opteron | Ticlodone | Ticlopidina | Ticlopidina age | Ticlopidina Almus | Ticlopidina big | Ticlopidina eg | Ticlopidina hexal | Ticlopidina Sandoz | Ticlopidina tecnigen | Tiklid;
  • (JO) Jordan: Prevoc | Ticlid;
  • (JP) Japan: Beachlon | Dilpender | Hishimidon | Iparazin | Maitojin | Neopidine | Nichistate | Nichistate nichiiko | Panaldine | Panapidin | Paraclodin | Patyuna | Pharlodine | Piclodin | Piclodin ohta | Piclodin teiyaku | Piclonadine kayaku | Piclonadine taiyo | Pietenale | Propacall | Propacall aventis | Propacall kyorin | Robetarl | Rondorin | Solozorin | Soper | Soper merck hoei | Ticpilone;
  • (KR) Korea, Republic of: Clobrine | Clodin | Clodine | Clopidine | Fosdin | Hawon ticlopidine | Hemoldin | Korus ticlopidine hcl | Lopidin | Tacron | Tarmol | Ticlin | Ticlodone | Ticlon | Ticlopidine | Tinalpin | Tipin | Yuyu clid;
  • (KW) Kuwait: Ticlid;
  • (LB) Lebanon: Ticlid;
  • (LT) Lithuania: Aclotin | Tagren | Ticlid | Ticlopidin Ratiopharm;
  • (LU) Luxembourg: Ticlid;
  • (LV) Latvia: Tagren | Ticlid;
  • (MA) Morocco: Thrombopat | Ticlid;
  • (MX) Mexico: Ticlid;
  • (MY) Malaysia: Antigreg | Aplaket | Apo-Ticlopidine | Dyna ticlopidine | Strokan | Tacron | Tagren | Ticlid | Ticlodine | Ticlopidine | Ticloproge | Tiodin | Tipidin;
  • (NL) Netherlands: Ticlid;
  • (NO) Norway: Ticlid;
  • (NZ) New Zealand: Ticlid;
  • (PE) Peru: Ticlid | Ticlopidina;
  • (PH) Philippines: Clotidone | Ticlid;
  • (PK) Pakistan: Tekopin | Teolid | Ticlid | Ticlop | Ticlopoli | Ziclodin;
  • (PL) Poland: Aclotin | Apo-clodin | Iclopid | Ifapidin | Ticlid | Ticlo | Ticlopid | Ticlopidine 1A Pharma;
  • (PR) Puerto Rico: Ticlid | Ticlopidine HCL;
  • (PT) Portugal: Aplaket | Betlife | Isaxion | Klodipin | Movin | Plaquetal | Previta | Ticlodix | Ticlopat | Ticlopidina | Ticlopidina wynn | Tiklyd | Tiropa | Trombopat;
  • (PY) Paraguay: Ticlid | Ticlopidina pasteur;
  • (RO) Romania: Ipaton;
  • (RU) Russian Federation: Ticlid | Ticlo;
  • (SA) Saudi Arabia: Prevoc | Ticlid;
  • (SE) Sweden: Ticlid | Ticlopidine Sanofi;
  • (SG) Singapore: Antigreg | Aplaket | Apo-Ticlopidine | Ticlid | Ticlopidine | Tilodene | Tiodin | Tipidin;
  • (SI) Slovenia: Tagren;
  • (SK) Slovakia: Aclotin | Ipaton | Ticlid | Ticlopidin;
  • (TH) Thailand: Aplaket | Cenpidine | Ticdine | Ticlid | Ticlodin | Ticlodinestar | Ticlopine | Ticolid | Tikol | Tilopin | Tipidine | Viladil;
  • (TN) Tunisia: Prevoc | Ticlid;
  • (TR) Turkey: Agretik | Ticlid | Ticlocard;
  • (TW) Taiwan: Antigreg | Declot | Kaniya | Kersyn | Labisu | Licodin | Menchuan | Nalodine | Nichistate | Panaldine | Pietenale | Sulomei | Ticlid | Ticlod | Ticlopidine | Ticlopine;
  • (UA) Ukraine: Aclotin | Ipaton | Tagren | Ticlid;
  • (UY) Uruguay: Pidina | Plaquetic | Ticlid;
  • (VE) Venezuela, Bolivarian Republic of: Ticlid | Ticlodone | Ticlopin;
  • (ZA) South Africa: Ticlid
  1. Adcirca (tadalafil) [prescribing informationt]. Indianapolis, IN: Eli Lilly and Company; April 2014
  2. Bell AD, Roussin A, Cartier R, et al, “The Use of Antiplatelet Therapy in the Outpatient Setting: Canadian Cardiovascular Society Guidelines,” Can J Cardiol, 2011, 27(Suppl A):1-59. [PubMed 21640290]
  3. Ferraris VA, Saha SP, Oestreich JH, et al, “2012 Update to the Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients Having Cardiac and Noncardiac Operations,” Ann Thorac Surg, 2012, 94(5):1761-81. [PubMed 23098967]
  4. Frontera JA, Lewin JJ 3rd, Rabinstein AA, et al; Guideline for reversal of antithrombotics in intracranial hemorrhage: a statement for healthcare professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocrit Care. 2016;24(1):6-46. [PubMed 26714677]
  5. Hass WK, Easton JD, Adams HP Jr, et al, “A Randomized Trial Comparing Ticlopidine Hydrochloride With Aspirin for the Prevention of Stroke in High-Risk Patients,” N Engl J Med, 1989, 321(8):501-7. [PubMed 2761587]
  6. Lindsay MP, Gubitz G, Bayley M, Phillips S; Canadian Stroke Best Practices and Standards Working Group. Canadian best practice recommendations for stroke care. Stroke Prevention. 4th ed. 2;2012.
  7. Pharmacy Quality Alliance. Use of high-risk medications in the elderly (2017 update) (HRM-2017). https://www.pqaalliance.org/medication-safety . Published 2017. Accessed March 21, 2019.
  8. Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(4):459-474. doi: 10.1038/ajg.2016.41. [PubMed 26925883]
  9. Ticlopidine hydrochloride tablets [prescribing information]. Pulaski, TN: AvKARE Inc; February 2012.
  10. Ticlopidine hydrochloride tablets [product monograph]. Toronto, Ontario, Canada: AA Pharma Inc; November 2017.
Topic 9996 Version 255.0

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