Ticlopidine belongs to the class of medications called platelet aggregation inhibitors or antiplatelets. It works by preventing certain types of blood cells, called platelets, from sticking together to form a blood clot. It is used to reduce the risk of stroke for people who have had a stroke or have particular risk factors for stroke. It is generally used to reduce the risk of stroke for people who cannot tolerate or are allergic to acetylsalicylic acid (ASA) or have failed treatment with ASA.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The usual recommended adult dose of ticlopidine is 250 mg twice daily.

Ticlopidine should always be taken with food or just after a meal to avoid stomach upset.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the one given here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not take ticlopidine if you:

• are allergic to ticlopidine or to any of the ingredients of the medication
• have certain blood disorders (such as neutropenia or thrombocytopenia)
• have medical conditions associated with active bleeding such as stomach ulcer or bleeding in the head (brain hemorrhage)
• have medical conditions associated with decreased or stopped blood flow
• have severely reduced liver function
• have thrombotic thrombocytopenic purpura

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal or stomach pain (mild)
• bloating or gas
• diarrhea
• dizziness
• heartburn
• itchiness
• loss of appetite
• nausea
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• general feeling of discomfort or illness
• purplish spots in the skin
• signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• signs of bleeding (e.g., bloody nose, blood in urine, coughing blood, cuts that don't stop bleeding)
• signs of infections (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• signs of liver damage (e.g., yellowing of eyes or skin, dark urine, light-coloured stools)
• skin rash

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e.g., swelling of face or throat, or difficulty breathing)
• signs of a stroke (e.g., sudden confusion, loss of coordination, paralysis, severe headache, difficulty speaking)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin taking a medication, be sure to inform your doctor of any medication conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Blood cell problems: A small percentage of people taking ticlopidine develop neutropenia (a lowering of white blood cells that fight infection in the body). Severe neutropenia occurs during the first 3 to 12 weeks of therapy and may develop quickly over a few days. The condition may be life-threatening. It is usually reversible; recovery usually occurs within 1 to 3 weeks after stopping the medication, but may take longer on occasion.

Thrombocytopenia (severe lowering of the platelets that help to clot the blood) is a rare but serious side effect caused by ticlopidine. Thrombocytopenia occurs during the first 3 to 12 weeks of therapy, and recovery usually occurs after the medication is stopped.

Thrombotic thrombocytopenic purpura is a rare condition that may occur while taking ticlopidine and requires immediate medical attention. Signs include thrombocytopenia (unusual bruising or bleeding, gums that bleed more easily), confusion, becoming easily tired, a rapid heartbeat, purplish spots in the skin, and fever.

All people taking ticlopidine need to have lab tests done every 2 weeks, beginning prior to the time you start the medication, until the end of the third month of treatment. This is to make sure no blood cell problems (such as those described above) occur. Your doctor will monitor your lab results regularly, so it is important to get your blood tests done as recommended by your doctor.

Blood clotting: If you take ticlopidine, you may bleed for a longer period of time, or your blood may require more time to clot. Report any signs of unexpected or excessive bleeding (e.g., nosebleeds, excessive bruising, black tarry stools) to your doctor. Other medications (e.g., ASA, warfarin) can increase the risk of longer blood clotting time, so let your doctor know of all medications you are taking.

Kidney function: If you have severely reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: People with severely reduced liver function should not take this medication. If you have reduced liver function, you should discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Surgery: It may be necessary to stop this medication temporarily if you are scheduled for surgery or are having teeth removed to ensure that you do not lose too much blood. It is important to inform all doctors involved in your care, that you are taking this medication.

Pregnancy: The medication should not be used during pregnancy. Your doctor should perform a pregnancy test before you start this medication. While using this medication, you should consider using more than one form of contraception. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if ticlopidine passes into breast milk. If you are a breast-feeding mother and are taking ticlopidine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of taking this medication have not been established for children.

There may be an interaction between ticlopidine and any of the following:

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.