Ticagrelor; Vorapaxar/Strong CYP3A4 Inducers Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Your medicine may speed up how quickly your body processes ticagrelor and vorapaxar.

What might happen:

The amount of ticagrelor or vorapaxar in your blood may decrease and it may not work as well.

What you should do about this interaction:

Make sure your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together or if you have used apalutamide, carbamazepine, enzalutamide, fosphenytoin, lumacaftor, mitotane, natisedine, phenobarbital, phenytoin, primidone, rifampin, rifapentine or St. John's wort in the previous two weeks. Your doctor may want to change one of your medicines, or more closely monitor how well your heart medicine is working.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Brilique (ticagrelor) UK summary of product characteristics. AstraZeneca UK Limited October 24, 2012.
  • 2.Brilinta (ticagrelor) US prescribing information. AstraZeneca LP March, 2018.
  • 3.Zontivity (vorapaxar) US prescribing information. Merck & Co., Inc. November, 2019.
  • 4.Pourdjabbar A, Hibbert B, Chong AY, Abunassar J, Malhotra N, Whitten TA, Le May MR, So DY. A pharmacodynamic analysis for the co-administration of inducers of CYP3A with ticagrelor: A cautionary tale in managing patients with acute coronary syndromes. Int J Cardiol 2016 Mar 24;214:423-425.
  • 5.Kosoglou T, Statkevich P, Kumar B, Xuan F, Schiller JE, Johnson-Levonas AO, Young S, Cutler DL. The effect of multiple doses of ketoconazole or rifampin on the single- and multiple-dose pharmacokinetics of vorapaxar. J Clin Pharmacol 2013 May;53(5):540-9.
  • 6.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and- drug-interactions-table-substrates-inhibitors-and-inducers. Updated 11/14/2017.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.