Drug interactions
Aspirin / citric acid / sodium bicarbonate + Ticagrelor
Severity: Major
Aspirin / citric acid / sodium bicarbonate and Ticagrelor: major interaction.
Last updated Sources: EMA SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Effervescent aspirin products typically contain analgesic doses of aspirin. Maintenance aspirin doses above 100 mg daily reduce the effectiveness of ticagrelor and add to bleeding risk.
What this interaction means in plain words
Aspirin / citric acid / sodium bicarbonate and Ticagrelor can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Pharmacodynamic interaction in which higher-dose aspirin appears to blunt ticagrelor's efficacy; the exact mechanism is not fully established.
What to do
Avoid regular use of analgesic-dose aspirin products with ticagrelor; keep maintenance aspirin at 75-100 mg daily. Use paracetamol for pain if suitable.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Ticagrelor
- Itraconazole + Ticagrelor Contraindicated
- Ketoconazole + Ticagrelor Contraindicated
- Levoketoconazole + Ticagrelor Contraindicated
- Abciximab + Ticagrelor Major
- Abrocitinib + Ticagrelor Major
- Acalabrutinib + Ticagrelor Major
Frequently asked questions
Can I take Aspirin / citric acid / sodium bicarbonate with Ticagrelor?
MediHelp rates the interaction as major. Aspirin / citric acid / sodium bicarbonate and Ticagrelor can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Effervescent aspirin products typically contain analgesic doses of aspirin. Maintenance aspirin doses above 100 mg daily reduce the effectiveness of ticagrelor and add to bleeding risk.
How serious is the interaction between Aspirin / citric acid / sodium bicarbonate and Ticagrelor?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid regular use of analgesic-dose aspirin products with ticagrelor; keep maintenance aspirin at 75-100 mg daily. Use paracetamol for pain if suitable.
What other medicines interact with Ticagrelor?
MediHelp also lists interactions of Ticagrelor with, for example, Itraconazole, Ketoconazole, Levoketoconazole. The full list is on the Ticagrelor page.
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