Ticlopidine

Harmful blood clots are the usual culprits which trigger strokes, and ticlopidine is a drug which can prevent the formation of these harmful blood clots, although it may be accompanied by some serious side effects.

Overview

Ticlopidine is a drug which is usually administered to patients who have already had a stroke, because it has been shown to be effective in reducing the likelihood of a second stroke. It is a very serious drug which is only recommended for patients who are unable to take aspirin as a stroke prevention medication, because there are known side effects which can be very serious for some patients, especially during the initial phase of treatment.

Ticlopidine reduces the chance of blood clots forming in the bloodstream, and since blood clots are the primary vehicle by which strokes are triggered, the drug can be effective in preventing strokes. However, the property which ticlopidine has for preventing the formation of blood clots works by thinning the blood, and this can lead to some dangerous situations when a person starts bleeding and a helpful blood clot cannot be formed.

Ticlopidine is available in tablet form, and requires the prescription of a doctor. Most doctors will only prescribe the drug in certain specific situations.

Condition Treated

  • Stroke prevention
  • Prevention of blood clots for coronary stents
  • Treatment of sickle cell disease

Type of Medicine

  • Platelet aggregation inhibitor

Side Effects

More than 50% of stroke patients who have been prescribed ticlopidine have experienced at least one or more side effects from using the drug, and the most frequently affected area is the gastrointestinal tract. Although in a majority of cases the adverse side effects from ticlopidine are relatively mild, there are still many instances where patients are forced to discontinue use of the drug because of the severity of side effects.

Diarrhea is one of the medical conditions which can become a fairly serious problem after taking ticlopidine, but rashes, nausea, vomiting, neutropenia, and gastrointestinal tract pain can also result from taking the drug. These symptoms typically appear within the first three months of a treatment program, although there is an additional likelihood of a second onset of side effects which can occur several months into a treatment program.

Apart from the gastrointestinal side effects, there are also hematological problems which can occur in the form of leukemia, agranulocytosis, pancytopenia, thrombocytosis, and bone marrow depression. In the hemorrhagic area, ticlopidine has been known to cause increased bleeding such as in the gastrointestinal area, as well as perioperative bleeding, and in some cases, spontaneous posttraumatic bleeding. It is also linked to several types of bleeding complications, including epistaxis, hematuria, conjunctival haemorrhage, and ecchymosis. Some rare cases of intracerebral bleeding have also been reported and linked to ticlopidine usage.

Some instances of rashes have appeared in patients using the drug, specifically maculopapular rash or urticarial rash, both of which most frequently occur during the first three months of therapy, usually within the first 10 days of treatment. A few reports have been filed of more severe rashes such as Stevens-Johnson syndrome, exfoliative dermatitis, and erythema multiforme.

Some situations have occurred which are very serious, and have proven fatal in rare cases for patients using ticlopidine. These include hemolytic anemia with reticulocytosis, arthropathy, myositis, allergic pneumonitis, hepatitis, hepatic necrosis, cholestatic jaundice, renal failure, thrombocytopenia, vasculitis, hepatic failure, hepatocellular jaundice, nephrotic syndrome, sepsis, hyponatremia, systemic lupus, peripheral neuropathy, and anaphylaxis.

Dosage

Dosages of ticlopidine will generally be different for all patients, since tolerances are different and medical history does come into play. Make sure to closely follow your doctor's instructions for ticlopidine usage, and strictly adhere to any directions which are printed on the container label. The dosage of medication that you take will depend on both the strength of the medication and the frequency of ingestion during the course of the day or week.

The following are to be considered typical dosages, and your own specific doses may be somewhat different, depending on your own medical profile.

When ticlopidine is used for the prevention of strokes in adults, one tablet of 250 mg is generally prescribed twice a day and should be taken in conjunction with a meal. Ticlopidine is not generally prescribed for child usage, especially for the prevention of strokes, and any cases which do involve child prescription would be specially determined by a pediatric physician.

When ticlopidine is used for the preventions of stroke or heart attack where a heart stent procedure has been involved, the typical adult dosage would again be 250 mg taken twice a day, along with food or a full meal. This would be accompanied by a doctor-recommended dosage of aspirin for as long as a month following your heart stent procedure.

If you should miss a regularly scheduled dosage of ticlopidine, you should take it as soon as you remember it. In cases where it is almost time for your next regularly scheduled dosage, you should skip the missed dose and just take the next dosage. You should never double up on dosages of ticlopidine just to catch up and get back on schedule.

Interactions

There are a number of other medications which have the potential to interact negatively with ticlopidine, so anyone taking one or more of the medications listed below should immediately inform the doctor, so that adjustments in treatment can be made. Typical therapeutic dosages of ticlopidine will often cause as much as a 30% increase in the plasma half-life of antipyrine, and can have the same kind of effects on other drugs which are similarly metabolized. Therefore, it may be necessary to adjust dosages with drugs that are metabolized by hepatic microsomal enzymes, particularly those with low therapeutic ratios.

One of the most common interactions of ticlopidine is with aspirin, and although the relative safety or danger of using both aspirin and ticlopidine has not currently been fully established, there is still a known interaction. While aspirin does not inhibit the effectiveness of ticlopidine, it does work the other way around, with ticlopidine reducing the effectiveness of aspirin. Therefore, it is not recommended to use these two drugs in tandem over a prolonged period of time.

Antacids also have a known impact on ticlopidine, reducing its effectiveness by almost 20%, which means their ingestion should be avoided during a treatment program which includes ticlopidine. Regular usage of cimetidine is known to decrease the effectiveness of ticlopidine by nearly half, and should not be used in conjunction with that drug.

When digoxin is used in conjunction with ticlopidine, there is no degradation of digoxin's effectiveness, but there can be as much as a 50% reduction in the effectiveness of ticlopidine. There is a fairly long list of other drugs which should not be taken in conjunction with ticlopidine, but which may be medically necessary on your doctor's recommendation. When any of the following medications is used concurrently with ticlopidine, there will likely be an adjustment in the normal dosage for either or both of the drugs:

  • Magnesium Trisilicate
  • Phenytoin
  • Theophylline
  • Abciximab
  • Aceclofenac
  • Acemetacin
  • Bemiparin
  • Bivalirudin
  • Bromfenac
  • Bufexamac
  • Bupropion
  • Alipogene Tiparvovec
  • Piracetam
  • Piroxicam
  • Proglumetacin
  • Propyphenazone
  • Alteplase, Recombinant
  • Amtolmetin Guacil
  • Anagrelide
  • Celecoxib
  • Certoparin
  • Apixaban
  • Niflumic Acid
  • Nimesulide
  • Tenoxicam
  • Tiaprofenic Acid
  • Tinzaparin
  • Tizanidine
  • Ardeparin
  • Argatroban
  • Aspirin
  • Choline Salicylate
  • Cilostazol
  • Dabigatran Etexilate
  • Dalteparin
  • Danaparoid
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Droxicam
  • Duloxetine
  • Edoxaban
  • Enoxaparin
  • Eptifibatide
  • Escitalopram
  • Citalopram
  • Clonixin
  • Clopidogrel
  • Clozapine
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Fenoprofen
  • Fepradinol
  • Paroxetine
  • Phenindione
  • Phenprocoumon
  • Phenylbutazone
  • Piketoprofen
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Heparin
  • Ibuprofen
  • Levomilnacipran
  • Desirudin
  • Desvenlafaxine
  • Dexibuprofen
  • Dexketoprofen Felbinac
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Fondaparinux
  • Meloxicam
  • Milnacipran
  • Morniflumate
  • Nabumetone
  • Nadroparin
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Lepirudin
  • Naproxen
  • Nimesulide Beta Cyclodextrin
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Parnaparin
  • Proquazone
  • Protein C
  • Reviparin
  • Rivaroxaban
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sodium Salicylate
  • Sulindac
  • Nefazodone
  • Magnesium Hydroxide
  • Magnesium Oxide
  • Nepafenac
  • Tolfenamic Acid
  • Tolmetin
  • Valdecoxib
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Warfarin
  • Aluminum Carbonate, Basic
  • Aluminum Hydroxide
  • Aluminum Phosphate
  • Calcium
  • Carbamazepine
  • Dihydroxyaluminum Aminoacetate
  • Dihydroxyaluminum Sodium Carbonate
  • Fosphenytoin
  • Magaldrate
  • Magnesium Carbonate

Warnings

There are a number of warnings and precautions which should be adhered to and observed by any patient who is considering a program of treatment which includes ticlopidine. First of all, it's extremely important that before any treatment is begun, blood tests be performed, and then they should be repeated every other week for the first three months of treatment. These tests will determine whether or not some of the known side effects of ticlopidine are in progress, and it is essential that such side effects are discovered early before they have a chance to become serious. It is therefore extremely important that you don't miss any regularly scheduled tests with your doctor, because of the potential for side effects to be developing.

If you are already underway with a treatment program of ticlopidine, you should inform all of the medical personnel in your support network, including dentists, nurses, doctors, and pharmacists, because of the potential for increased bleeding while taking ticlopidine. This can impact any medications they might prescribe, and it can also lead to serious complications if you undergo any kind of dental surgery, since bleeding could become a problem. If any such oral surgery, or any kind of general surgery, becomes necessary while you are on a program of treatment with ticlopidine, it may be necessary to discontinue your ticlopidine treatment for several weeks in order to safely accommodate the surgery.

You should be aware that any kind of accident which triggers bleeding could escalate into a serious situation, because ticlopidine inhibits the body's ability to form helpful blood clots, so it could be difficult to stop accidental bleeding.

If you encounter bruising or bleeding that becomes extremely hard to control, you should immediately notify your doctor, or if you notice bleeding from the gums while brushing or flossing your teeth, this should be related to your family doctor.

Sometimes bleeding can occur inside the body without you being aware of it, and in such cases, you may notice a tendency toward faintness during your waking hours, or you may see a change in your stools, with them becoming cloudy, black, tarry.

You should also not notify your doctor if you experience fevers, sore throats, or chills, since these can be signs of infection. If you happen to notice sores, ulcers, or white spots inside your mouth, these can also be cause for concern and should be discussed with your doctor.

Make sure to tell your doctor if you are allergic to ticlopidine, or any of the ingredients which are used in its manufacture. You should also let your doctor know if you are already taking any other kinds of medications, vitamins, herbal products, nutritional supplements, antacids, anticoagulants, or over-the-counter drugs which might interact with ticlopidine. If you are taking antacids regularly, make sure to take them at least an hour - and probably two hours - after your normal dosage of ticlopidine.

It's important that your doctor knows if you have any family history of bleeding ulcers, or other bleeding disorders, low blood cell count, liver disease, kidney disease, high blood pressure, high blood cholesterol, or a high incidence of triglycerides.

Also make sure your doctor is aware if you are currently pregnant, if you plan to become pregnant, or if you are either currently breastfeeding or plan to breastfeed following pregnancy. If you become pregnant while on a treatment program involving ticlopidine, you should immediately contact your doctor to discuss the situation.

All patients who are 65 years of age or older should have a serious discussion with their doctor about the risks and benefits of being treated with ticlopidine. In most cases, doctors will not recommend ticlopidine for seniors, because there are other medications which are just as effective and safer for that age group.

You should be alert for all these precautions and warnings for several weeks after discontinuing a program of treatment with ticlopidine, since any or all of these may still appear for up to a month following treatment.

Storage

Ticlopidine should be maintained in the package or container which it came in, and should be tightly sealed, well out of the reach of children and pets. Ideally, it should be stored in a location high above the reach of children where they cannot access it, even by climbing. Ticlopidine should be stored at room temperature, away from excessive heat, light, and moisture. Bathrooms are therefore not a good place for storage of ticlopidine, because the bathroom medicine cabinet is subject to periodic episodes of high humidity and heat when showers or bathing are in progress.

Any unused ticlopidine medication, or tablets which have exceeded their expiration date, should be disposed of in a safe manner. If you are uncertain about how to dispose of unused portions of your medication, consult with your doctor or pharmacist, or bring those unused tablets into your doctor's office.

Make sure that ticlopidine is not included along with other medications you may have in your weekly pill reminder container because very few of these include the necessary safety features which will prevent child access. Make sure that safety caps are always in place on your ticlopidine medication so that in the event of accidental access by children, the safety lock feature of the container will still prevent access.

If you suspect that a child has gotten into your ticlopidine medication, you should immediately call the Poison Control Center and take whatever steps are recommended for the specific situation.

Summary

Ticlopidine is a medication belonging to the class known as platelet aggregation inhibitors, meaning that it has the ability to deter or prevent the formation of harmful blood clots. Some blood clots which form in or travel to the brain can cause strokes that severely debilitate a person. Ticlopidine is especially indicated for people who have already experienced a stroke at some point, and are at risk for a recurrence.

The drug is not generally prescribed for young persons and is also not commonly used to treat seniors since seniors are more at risk for some of the harmful side effects of the drug. Other medications can be used just as effectively in seniors to prevent stroke, without the ‘blood thinner’ risk associated with ticlopidine.

There are a number of potential side effects associated with ticlopidine usage, and some of these are known to be fairly serious, so it is extremely important that any patient being treated with this drug keep all doctor’s appointments, so that side effects can be noted before they become serious. Any side effects which will occur are most likely to be manifested during the initial three months of treatment, and if none appear during this phase, it becomes more likely that ticlopidine can be used safely with no negative impacts on the patient.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
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