Drug interactions
Ticagrelor + Tucatinib
Severity: Major
Ticagrelor and Tucatinib: major interaction.
Last updated
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
Tucatinib is a strong CYP3A inhibitor and can substantially raise exposure to ticagrelor, a CYP3A4 substrate. Increased ticagrelor exposure raises the risk of bleeding, and dyspnea may also become more frequent.
What this interaction means in plain words
Ticagrelor and Tucatinib 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.
Ticagrelor belongs to Cardiovascular; Tucatinib belongs to Oncology.
Why it happens
Tucatinib inhibits CYP3A4, reducing ticagrelor metabolism and increasing its plasma concentrations.
What to do
Avoid the combination where possible and consider an alternative P2Y12 inhibitor such as prasugrel or clopidogrel according to indication. If it cannot be avoided, monitor closely for bleeding.
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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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 Tucatinib
- Cisapride + Tucatinib Contraindicated
- Eletriptan + Tucatinib Contraindicated
- Ergotamine + Tucatinib Contraindicated
- Flibanserin + Tucatinib Contraindicated
- Ranolazine + Tucatinib Contraindicated
- Amobarbital + Tucatinib Major
Frequently asked questions
Can I take Ticagrelor with Tucatinib?
MediHelp rates the interaction as major. Ticagrelor and Tucatinib 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. Tucatinib is a strong CYP3A inhibitor and can substantially raise exposure to ticagrelor, a CYP3A4 substrate. Increased ticagrelor exposure raises the risk of bleeding, and dyspnea may also become more frequent.
How serious is the interaction between Ticagrelor and Tucatinib?
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 P2Y12 inhibitor such as prasugrel or clopidogrel according to indication. If it cannot be avoided, monitor closely for bleeding.
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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