Antacids Comb.
Adverse Effect: Decreased ticlopidine effectiveness Clinical Management: Concurrent administration of ticlopidine and antacids is not recommended. If concurrent use cannot be avoided, ticlopidine should be taken at least one to two hours before the antacid dose.
Aspirin
Adverse Effect: Increased risk of bleeding Clinical Management: The concurrent use of aspirin and ticlopidine should be accompanied by close monitoring of blood counts.
Carbamazepine
Adverse Effect: An increased risk of carbamazepine toxicity (ataxia, nystagmus, diplopia, headache, vomiting, apnea, seizures, coma) Clinical Management: Monitor patients for signs of carbamazepine toxicity if ticlopidine is added to their therapeutic regimen. carbamazepine plasma level is useful if toxicity is suspected and downward dosing adjustments may be necessary. The carbamazepine dose need to be increased when ticlopidine is discontinued.
Cimetidine
Adverse Effect: Decreased ticlopidine bioavailability
Cyclosporin
Adverse Effect: Decreases Cyclosporine concentrations and reduces its efficacy #Clinical Management: Monitor Cyclosporine concentrations and adjust the dosage accordingly.
Omeprazole
Adverse Effect: increased omeprazole bioavailability
Phenytoin
Adverse Effect: An increased risk of phenytoin toxicity (ataxia, hyperreflexia, nystagmus, tremor) Clinical Management: Observe patients for signs and symptoms of phenytoin intoxication (ataxia, hyperreflexia, nystagmus, tremor). It is likely that doses of phenytoin will need to be reduced when ticlopidine is added to therapy and increased when the antithrombotic is withdrawn. It may be helpful to measure phenytoin serum concentrations (therapeutic range: 10 to 20 mcg/ml).
Theophylline
Adverse Effect: Theophylline toxicity (nausea, vomiting, palpitations, seizures) Clinical Management: Theophylline serum concentrations should be closely monitored when ticlopidine is added, discontinued, or when dosing changes occur. Dosing adjustments of theophylline may be necessary.
Warfarin
Adverse Effect: Increase in the concentration of the R-warfarin enantiomer and/or an increased risk of bleeding Clinical Management: Although this pharmacokinetic interaction is of minimal clinical significance, patients should still have their international normalized ratio (INR) checked periodically while receiving warfarin and ticlopidine due to large interpatient variability |