Drug interactions
Primidone + Ticagrelor
Severity: Major
Primidone and Ticagrelor: major interaction.
Last updated Sources: UK 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
Primidone, partly metabolized to phenobarbital, induces CYP3A4 and can lower ticagrelor and active metabolite levels. This may reduce antiplatelet effect and raise the risk of stent thrombosis or ischemic events.
What this interaction means in plain words
Primidone 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.
Primidone belongs to Central Nervous System; Ticagrelor belongs to Cardiovascular.
Why it happens
Induction of CYP3A4 increases the metabolism of ticagrelor.
What to do
Avoid the combination where possible and consider an alternative anticonvulsant without enzyme-inducing effects. If unavoidable, consider a different antiplatelet.
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
Other interactions of Primidone
- Lorlatinib + Primidone Contraindicated
- Lurasidone + Primidone Contraindicated
- Primidone + Ranolazine Contraindicated
- Primidone + Sofosbuvir-velpatasvir-voxilaprevir Contraindicated
- Primidone + Voriconazole Contraindicated
- Abiraterone + Primidone Major
Frequently asked questions
Can I take Primidone with Ticagrelor?
MediHelp rates the interaction as major. Primidone 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. Primidone, partly metabolized to phenobarbital, induces CYP3A4 and can lower ticagrelor and active metabolite levels. This may reduce antiplatelet effect and raise the risk of stent thrombosis or ischemic events.
How serious is the interaction between Primidone 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 the combination where possible and consider an alternative anticonvulsant without enzyme-inducing effects. If unavoidable, consider a different antiplatelet.
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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