Can Aspirin be used in combination of Ticagrelor

What does Aspirin treat?

Aspirin is an analgesic, non-steroidal anti-inflammatory drug which is used widely for the treatment of fever, inflammation and mild to moderate pain.

Aspirin also plays a key role in the treatment of inflammatory diseases such as rheumatoid arthritis (a progressive autoimmune disease primarily causes inflammation in joints), osteoarthritis (a disease of joint caused by breakdown of joint cartilage) and to reduce the risk of heart attack and deaths caused by heart attack.

Aspirin is usually recommended for the patients of ischemic stroke (blockage of blood flow to brain due to blood clot) or mini stroke (blockage of blood flow to brain for short time).

This drug is also used to treat the angina (sensation of chest pain occur when heart muscle does not get enough oxygen). The drug is available under generic name Acetylsalicylic acid (ASA) and brand name Aspirin.

The active component of the drug aspirin is salicylic acid, which was initially isolated by Edward Stone from the bark of willow tree in 1763. The drug was first chemically synthesized by Felix Hoffmann at Bayer in 1897.

Aspirin is available as acetylsalicylic acid, which is a synthetic pharmaceutical aromatic homomonocyclic compound with a molecular formula C₉H₈O_4.

The drug Aspirin is chemically known as 2-(acetyloxy) benzoic acid. It is available in the form of regular strength tablets and caplets, extra strength tablet, delayed-release tablet and quick chewable tablets for oral administration with food or without food.

What is Ticagrelor?

Ticagrelor (trade name Brilinta in the US, Brilique and Possia in the EU) belongs to a class of drugs called antiplatelets. It is a P2Y₁₂ platelet aggregation inhibitor. The drug is produced by AstraZeneca.

Ticagrelor is a prescription drug that is available only as a brand name drug called Brilinta and not available as a generic drug. Ticagrelor is indicated for reducing the risk of stroke, heart attack, or death in case of patients with acute coronary syndrome (ACS) or a history of myocardial infarction (MI).

Ticagrelor is also recommended to prevent blood clots formation in people with coronary stents (metal tubes surgically placed in clogged blood vessels to improve blood flow) who have had a heart attack or severe chest pain.

Ticagrelor is a nucleoside analogue and has a molecular formula C₂₃H₂₈F₂N₆O₄S. The drug is a synthetic pharmaceutical compound and belongs to the class of organic compounds known as triazolopyrimidines which are polycyclic aromatic compounds containing triazole ring fused to a pyrimidine ring.

Chemically it is known as (1S,2S,3R,5S)-3-[7-{[(1R,2S)-2-(3,4-difluorophenyl)cyclopropyl]amino}-5(propylthio)-3H-[1,2,3]-triazolo[4,5-d]pyrimidin-3-yl]-5-(2-hydroxyethoxy)cyclopentane-1,2-diol.

The active component of the drug is Ticagrelor besides other inactive ingredients. The drug is supplied in the form of tablets in two varying doses of 90 mg and 60 mg to be taken orally with or without food two times a day.

How does Aspirin and Ticagrelor work in the body?

Aspirin is a non-steroidal anti-inflammatory drug that inhibits cyclooxygenase (COX) enzyme therefore known as COX inhibitor agent.

The action of both acetyl and salicylate component of the acetylsalicylic acid (ASA or Aspirin) and its active metabolite salicylate are liable for the anti-inflammatory and analgesic properties through inhibition of cyclooxygenases.

ASA inhibits the COX (both COX-1 and COX-2) activity by binding to it irreversibly.  Inhibition of COX results in reduced formation of precursors of prostaglandins and thromboxane from arachidonic acid.

Antipyretic effect of ASA is resulted from the intervention in production of Prostaglandin E₁ which is a potent pyretic agent. ASA also inhibit the aggregation of platelets. This inhibitory effect of ASA is resulted from the intervention in production of Thromboxane A₂ which is accountable for the platelets aggregation.

The mode of action of Ticagrelor is similar to those of other thienopyridines including clopidogrel, prasugrel and ticlopidine. Ticagrelor and its major metabolite bind reversibly with adenosine diphosphate (ADP) receptors of subtype P2Y12 thereby preventing signal transduction and platelet activation.

However, the binding site of Ticagrelor in contrast to the other antiplatelet drugs is different from ADP, which makes it an allosteric antagonist. The blockage is reversible.

Besides, the drug does not need to be metabolized by the hepatic system to become active which is beneficial for the patients with genetic variants regarding the enzyme CYP2C19.

Can both Aspirin and Ticagrelor be taken together in combination?

Aspirin and Ticagrelor interaction: Yes, Ticagrelor in combination with Aspirin represents a valuable, safe, and effective therapeutic regimen for the treatment of acute coronary syndrome (MI or unstable angina).

Ticagrelor, a potent P2Y12 inhibitor together with Aspirin provides a standard therapy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients undergoing percutaneous coronary intervention (PCI).

For the treatment of ACS, the recommended initial loading dose of Aspirin is 325 mg, which is to be followed by the maintenance dose of 75-100 mg/day. It is recommended not to exceed the Aspirin dose above 100 mg per day as it causes a reduction in the effectiveness of Ticagrelor.

Safety and precautions while taking Aspirin:Ticagrelor combination

• It is always recommended that analgesia should be dose–limited when used in combination due to their increased side effects. Caution should be taken before using Aspirin in combination with Ticagrelor.
• Do not use the medicine if you are hypersensitive or allergic (e.g., anaphylaxis) to Ticagrelor or nonsteroidal anti-inflammatory drugs (i.e. ibuprofen, naproxen, celecoxib) or salicylates, or to any ingredient of the drug formulation.
• The drugs are also not recommended in case of patients with a history of bleeding problems or a history of stomach or intestinal bleeding and should be used with caustion in patients with a history of asthma.
• Ticagrelor and Aspirin may interact with other drugs. Therefore, care should be taken when you are taking any prescription or non-prescription medicines and herbal or vitamin supplements.
• It is advisable that you do not start, stop or change or take any medicine unless you have discussed with your doctor or professional consult as it may increase the chance of having a heart attack, blood clotting problems, or other serious conditions.
• The uptake of drugs should be hold or stopped in case a patient is undergoing any test, procedure or surgery and then should be restarted later.
• Do not share the medications with other persons having the similar kind of problems. Consult your doctor for more details.
• Aspirin and Ticagrelor are generally not recommended to be taken in case of pregnancy and breastfeeding.
• The drugs are usually not recommended to be taken along with alcohol.

“Can I take Niacin and Aspirin together?”
“Belviq (Lorcaserin) dosing, indications, interactions, adverse effects”