Acetaminophen, caffeine, and dihydrocodeine and Ticagrelor

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer information for this interaction is not currently available.MONITOR: Coadministration with opioid agonists may delay and reduce the absorption of orally administered P2Y12 inhibitors (e.g., clopidogrel, prasugrel, ticagrelor). The proposed mechanism may involve opioid-mediated slowed gastric emptying. In one study, IV morphine (5 mg) given immediately prior to a loading dose of clopidogrel (600 mg) decreased the systemic exposure (AUC) and maximum concentration (Cmax) of the active metabolite of clopidogrel by 34% and increased the time to peak concentration (Tmax) of clopidogrel when compared with placebo (105 minutes vs 83 minutes, respectively). In addition, morphine reduced the pharmacodynamic (antiplatelet) effects of clopidogrel. In another study, IV morphine (5 mg) given immediately prior to a loading dose of ticagrelor (180 mg) decreased the AUC of ticagrelor and its active metabolite by approximately 36%, doubled the Tmax of ticagrelor, and reduced the antiplatelet effects of ticagrelor. The clinical relevance of this interaction is unknown. The risks associated with other opioid agonists are also unknown. MANAGEMENT: Although data are limited, caution is recommended when orally administered P2Y12 inhibitors are given concomitantly with opioid agonists. In acute coronary syndrome patients who require an opioid agonist, the use of a parenteral antiplatelet agent, such as cangrelor, should be considered. References Hobl EL, Reiter B, Schoergenhofer C, et al. "Morphine Decreases Ticagrelor Concentrations but not its Antiplatelet Effects: A Randomized Trial in Healthy Volunteers." Eur J Clin Invest 46 (2015): 7-14 Cerner Multum, Inc. "Australian Product Information." O 0 Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 Kubica J, Adamski P, Ostrowska M, et al. "Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial." Eur Heart J (2015): Hobl EL, Stimpfl T, Ebner J, et al. "Morphine Decreases Clopidogrel Concentrations and Effects: A Randomized, Double Blind, Placebo-Controlled Trial." J Am Coll Cardiol (2013): Kubica J, Kubica A, Jilma B, et al. "Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors." Int J Cardiol 215 (2016): 201-208 "Product Information. Plavix (clopidogrel)." Bristol-Myers Squibb, Princeton, NJ. "Product Information. Brilinta (ticagrelor)." Astra-Zeneca Pharmaceuticals, Wilmington, DE. Cerner Multum, Inc. "Canadian Product Information." O 0 (2015): "Product Information. Effient (prasugrel)." Lilly, Eli and Company, Indianapolis, IN. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. Available from: URL: https://cima.aemps.es/cima/publico/home.html." ([2018]): Hobl EL, Reiter B, Schoergenhofer C, et al. "Morphine interaction with prasugrel: a double-blind, cross-over trial in healthy volunteers." Clin Res Cardiol 105 (2015): 349-55 View all 12 references

MONITOR: Coadministration with opioid agonists may delay and reduce the absorption of orally administered P2Y12 inhibitors (e.g., clopidogrel, prasugrel, ticagrelor). The proposed mechanism may involve opioid-mediated slowed gastric emptying. In one study, IV morphine (5 mg) given immediately prior to a loading dose of clopidogrel (600 mg) decreased the systemic exposure (AUC) and maximum concentration (Cmax) of the active metabolite of clopidogrel by 34% and increased the time to peak concentration (Tmax) of clopidogrel when compared with placebo (105 minutes vs 83 minutes, respectively). In addition, morphine reduced the pharmacodynamic (antiplatelet) effects of clopidogrel. In another study, IV morphine (5 mg) given immediately prior to a loading dose of ticagrelor (180 mg) decreased the AUC of ticagrelor and its active metabolite by approximately 36%, doubled the Tmax of ticagrelor, and reduced the antiplatelet effects of ticagrelor. The clinical relevance of this interaction is unknown. The risks associated with other opioid agonists are also unknown.

MANAGEMENT: Although data are limited, caution is recommended when orally administered P2Y12 inhibitors are given concomitantly with opioid agonists. In acute coronary syndrome patients who require an opioid agonist, the use of a parenteral antiplatelet agent, such as cangrelor, should be considered.

Acetaminophen, caffeine, and dihydrocodeine

Generic Name: acetaminophen / caffeine / dihydrocodeine

Brand name: Dvorah, Panlor Tablet, Trezix, Panlor DC, Panlor SS, Zerlor

Synonyms: Acetaminophen, Caffeine, and Dihydrocodeine

What is Acetaminophen, caffeine, and dihydrocodeine?

Ticagrelor

Generic Name: ticagrelor

Brand name: Brilinta

Synonyms: n.a.

What is Ticagrelor?