Ticalog Tablet 90mg

Indications

Ticalog, when used alongside acetylsalicylic acid (ASA), is indicated for the prevention of atherothrombotic events in adult patients with acute coronary syndromes (ACS) or a history of myocardial infarction (MI) who are at high risk for these events.

Pharmacology

Tigecycline, the active ingredient in Ticalog, is a glycylcycline antibacterial agent administered via intravenous infusion. It works by inhibiting protein translation in bacteria through binding to the 30S ribosomal subunit, which blocks the entry of amino-acyl tRNA into the ribosome's A site. This mechanism prevents the incorporation of amino acids into growing peptide chains. No cross-resistance has been observed between tigecycline and other antibacterial agents.

Dosage & Administration

Patients taking Ticalog should also take a daily maintenance dose of acetylsalicylic acid (ASA) at 75-150 mg, unless contraindicated.

• Acute Coronary Syndromes: Start with a loading dose of 180 mg (two 90 mg tablets), followed by 90 mg twice daily. Continue this regimen for 12 months unless discontinuation is clinically warranted.

• History of Myocardial Infarction: For extended treatment in patients with a history of MI (at least one year prior) and high atherothrombotic risk, the recommended dose is 60 mg twice daily. Treatment may begin without interruption after the initial one-year treatment or after stopping another ADP receptor inhibitor.

• Switch Therapy: If switching from another antiplatelet medication, administer the first dose of Ticalog 24 hours after the last dose of the previous medication.

• Missed Dose: If a dose is missed, take the next scheduled dose as usual—do not double the dose.

• Elderly: No dosage adjustment is required.

• Renal Impairment: No dose adjustment is necessary; however, Ticalog is not recommended for patients on renal dialysis due to a lack of data.

• Hepatic Impairment: Contraindicated in patients with severe hepatic impairment. Caution is advised in those with moderate hepatic impairment; no adjustment is needed for mild impairment.

• Pediatric Population: Safety and efficacy have not been established for children under 18.

Ticalog can be taken with or without food.

Interactions

• CYP3A4 Inhibitors: Strong inhibitors (e.g., clarithromycin, ritonavir) should not be co-administered with Ticalog.

• CYP3A Inducers: Co-administration with potent inducers (e.g., rifampicin) is discouraged as it may reduce Ticalog's efficacy.

• Cyclosporine: Caution is advised when used with P-glycoprotein inhibitors.

• CYP2C9 Substrates: Ticalog is not a CYP2C9 inhibitor, so it is unlikely to affect medications like warfarin.

• Oral Contraceptives: No clinically relevant interactions expected.

• Bradycardia Inducers: No significant adverse reactions noted with known bradycardia-inducing medications.

• Other Therapies: Generally, no significant interactions with acetylsalicylic acid, proton pump inhibitors, statins, and others. Caution is advised when used with agents that affect hemostasis.

Contraindications

• Hypersensitivity to Ticalog or its components
• Active pathological bleeding
• History of intracranial hemorrhage
• Severe hepatic impairment

Side Effects

• Very Common: Bleeding disorders, hyperuricemia, dyspnea.
• Common: Gout, dizziness, headache, hypotension, gastrointestinal issues, rash, urinary bleeding.
• Uncommon: Severe bleeding (tumor, intracranial, eye), confusion.

Pregnancy & Lactation

Ticalog is not recommended during pregnancy. It is excreted in breast milk, and its safety for nursing infants is not established. Decisions should weigh the benefits of breastfeeding against the need for treatment.

Precautions & Warnings

• Bleeding Risk: Use caution in patients at higher risk for bleeding.
• Surgery: Discontinue Ticalog 5 days before elective surgery.
• Dyspnea Risk: Caution in patients with asthma or COPD.
• Creatinine Monitoring: Check renal function after one month of treatment, especially in high-risk groups.
• Uric Acid Monitoring: Hyperuricemia may occur; use caution in patients with gout.
• Discontinuation Risks: Premature stopping of Ticalog may increase the risk of cardiovascular events.

Overdose Effects

Ticalog is well tolerated in single doses up to 900 mg. Overdose may lead to gastrointestinal toxicity and respiratory issues.

Therapeutic Class

Anti-platelet drugs

Storage Conditions

Store in a cool, dry place, protected from light.