Ticagrelor is used along with low-dose aspirin to help prevent heart attack and stroke in people with a history of heart disease, stroke, or at increased risk for heart disease or stroke (for example, due to diabetes, history of transient ischemic attack-TIA). It may also prevent blood clots after certain heart surgeries (such as stent placement).

Ticagrelor works by blocking platelets from sticking together and prevents them from forming harmful clots. It is an antiplatelet drug. It keeps blood flowing smoothly in your body.

Read the Medication Guide provided by your pharmacist before you start taking ticagrelor and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually twice daily. The dosage and length of treatment are based on your medical condition and response to treatment. Take a low-dose aspirin (usually 75-100 milligrams) once a day if directed by your doctor. Follow your doctor's directions carefully. See also Warning section.

If you have trouble swallowing ticagrelor, you may crush the tablet. Mix the crushed tablet with water in a glass, then drink the mixture right away. Refill the glass with water, stir, and drink to make sure you take all of your dose.

If you are giving this medication through a feeding tube, ask your health care professional for detailed instructions on how to properly mix and give it.

Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

Do not increase your dose or take this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.

Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. If you stop taking this medication early, you may have a higher risk of getting a heart attack or stroke.

Shortness of breath, headache, dizziness, nausea, and nosebleed may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Although unlikely, serious bleeding may occur. Tell your doctor right away if you have any serious side effects, including:

• easy bruising/bleeding
• bleeding that is severe or that you cannot control (such as a severe nosebleed that you cannot stop)
• bloody/black stools
• vomit with blood or that looks like coffee grounds
• bloody/red/pink/dark urine

Tell your doctor right away if you have any serious side effects, including:

• interrupted breathing during sleep

Get medical help right away if you have any very serious side effects, including:

• fast/slow/irregular heartbeat
• fainting
• confusion
• trouble speaking
• vision changes
• signs of a blood clotting problem (such as red/purple pinpoint-sized spots on the skin, fever)

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before taking ticagrelor, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• bleeding problems (such as bleeding in the brain, hemophilia, ulcers, frequent nosebleeds)
• gout
• liver disease
• recent surgery
• serious injury/trauma
• heart rhythm problems (heart block or fast/slow/irregular heartbeat)

This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis). This medicine can cause stomach bleeding. Daily use of alcohol while using this medicine may increase your risk for stomach bleeding.

To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Your doctor or dentist may tell you to temporarily stop ticagrelor at least 5 days before surgery or a dental procedure. Carefully follow your doctor's or dentist's specific directions for when to stop or restart this medication.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this drug passes into breast milk. Consult your doctor before breastfeeding.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include:

• mifepristone
• other drugs that can cause bleeding/bruising (including other antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, "blood thinners" such as dabigatran/warfarin)

Other medications can affect the removal of ticagrelor from your body, which may affect how ticagrelor works. Examples include dexamethasone, nefazodone, ritonavir, telithromycin, azole antifungals (such as itraconazole, ketoconazole), HIV protease inhibitors (such as atazanavir), macrolide antibiotics (such as clarithromycin), rifamycins (such as rifampin), drugs used to treat seizures (such as carbamazepine, phenytoin), among others.

Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (aspirin, NSAIDs such as ibuprofen or naproxen). These drugs are similar to ticagrelor and may increase your risk of side effects if taken together. However, if your doctor has told you to take low-dose aspirin to prevent heart attack or stroke (usually at dosages of 75-100 milligrams a day), you should keep taking the aspirin unless your doctor tells you not to. Ask your doctor or pharmacist for more details.

This medication may interfere with certain lab tests (such as platelet functional tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call 1-800-222-1222. Canada residents can call 1-844-764-7669. Symptoms of overdose may include: severe bleeding, nausea, vomiting, diarrhea, irregular heartbeat.

Do not share this medication with others.

Lab and/or medical tests (such as complete blood count) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).