Acora tablet: Each coated tablet contains Ticagrelor INN 90 mg.
Acora ® is a preparation of Ticagrelor. It is a cyclopentyltriazolopyrimidine which is a reversible platelet aggregation inhibitor. Ticagrelor reversibly binds with the platelet P2Y12 adenosine diphosphate (ADP) receptors and thereby inhibits signal transduction and platelet aggregation. In contrast to the other antiplatelet drugs, Ticagrelor has a binding site different from ADP, making it an allosteric antagonist, and the blockage is reversible. Moreover, the drug does not need hepatic activation, which might work better for patients with genetic variants regarding the enzyme CYP2C19.
Route: Oral
Adults:
Initiation: 180 mg loading dose (two 90 mg tablets) with Aspirin (325 mg).
Maintenance: 90 mg twice daily with Aspirin (75–100 mg). If a dose is missed, take only one tablet at the next scheduled time.
Strong CYP3A4 inhibitors (ketoconazole, clarithromycin) increase ticagrelor exposure and bleeding risk; strong CYP3A inducers (rifampin, carbamazepine, phenytoin) decrease efficacy; high-dose aspirin (>100 mg daily) attenuates clinical benefit; increases serum digoxin levels (monitor digoxin concentrations).
Ticagrelor is contraindicated in patients with hypersensitivity (e.g. angioedema) to Ticagrelor or any component of the product. It is also contraindicated in patients with a history of intracranial hemorrhage (ICH) because of a high risk of recurrent ICH in this population and patients with active bleeding disorders (e.g., peptic ulcer and intracranial hemorrhage). Ticagrelor is contraindicated in patients with severe hepatic impairment because of a probable increase in exposure, and it has not been studied in these patients. Severe hepatic impairment increases the risk of bleeding because of reduced synthesis of coagulation proteins.
Common: Bleeding, dyspnea. Less Common: Headache, back pain, nausea, dizziness, cough, hypotension, fatigue, atrial fibrillation.
Overdose
There is currently no known treatment to reverse the effects of Ticagrelor, and Ticagrelor is not expected to be dialyzable. Treatment of overdose should follow the local standard medical practice. Bleeding is the expected pharmacologic effect of overdosing. If bleeding occurs, appropriate supportive measures should be taken. Other effects of an overdose may include gastrointestinal effects (nausea, vomiting, and diarrhea) or ventricular pauses. Monitor the ECG.
Category C. No adequate and well-controlled studies in pregnant women; use during pregnancy only if potential benefit justifies fetal risk. Lactation: Human milk excretion unknown; nursing is not recommended.
Store below 30°C in a cool, dry place. Protect from light and moisture. Keep out of reach of children.