Pharmacopeia

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Field ASPIRIN
Haematology · Haematology · Level 2
CLOPIDOGREL
Haematology · Haematology · Level 2
TICAGRELOR
Haematology · Haematology · Level 2
ABCIXIMAB
Haematology · Haematology · Level 3
TIROFIBAN
Haematology · Haematology · Level 3
Mechanism of action

Non-specific Irreversible platelet cyclooxygenase inhibitor
(COX-1 and 2) via acetylation of serine residues → ↓formation PG precursors.
- Inhibits formation of thromboxane (TXA) → inhibit aggregation
- At higher doses prostacyclin (PFI2) synthesis also inhibited → vasoconstriction (but endothelium can regenerate COX)

Prodrug. Hepatic activation to active agent (Thiol derivative, by oxidation and hydrolysis) which is an ADP receptor antagonist
- Irreversible inhibition of P2Y12 receptor at platelet surface → Inhibits activation of GPIIb/IIIa → Inhibits platelet activation

Allosteric, reversible antagonist at P2Y12-R (an ADP receptor), preventing activation of glycoprotein IIb/IIIa→ prevents platelet crosslinking

Similar mechanism as tirofiban but monoclonal
antibody

Antagonises the GpIIb/IIIa
receptor, preventing the
binding of fibrinogen and
platelet crosslinking and
aggregation.

Absorption

- PO. BA. 50%.
- 300mg Loading. 100mg maint.

- PO. BA 50%
- 600mg loading. 75mg maint.

BA=40%

— —
Protein binding

85% protein binding, pKa 3

95% protein binding,

— — —
Volume of distribution

Vd 10L

Vd unknown

— — —
Metabolism

- Converted to salicylic acid in GI mucosa and liver
- Hepatic conjugation (saturable)

- Hepatic CYP450 2C19 + Esterases to Inactive metab

Metabolized by CYP3A4

Platelet function
typically returns to
normal 24-48 hours after
infusion ceases

Limited metabolism in humans.

Excretion

- Renal as salicylate

- Renal and faecal elimination

—

Platelet function
typically returns to
normal 24-48 hours after
infusion ceases

Excreted in urine and faeces, mostly
unchanged

Half-life

- T1/2b 15~20 mins when first order
- Dur: 4-6 hrs. (Effect on platelet aggregation will last life of current cohort of platelets (7-10 days)

- T1/2b 7 hours parent drug (30mins metab) Dur: life of platelet

— —

HL 1.9-2.2 hrs

Adverse Effects Toxicity

Bleeding
Bronchospasm, Renal toxicity
Reye’s Syndrome, GI ulceration
Caution with other anticoagulants

Bleeding
TTP
Agranulocytosis, Neutropenia
Significant drug interactions as requires activation by CYP450

—

Haemorrhage, thrombocytopenia, human antichimeric antibody development, allergic reaction

Haemorrhage
Difficulty reversing agent
Dose adjustment in renal impairment

Class Group

Antiplatelet

Antiplatelet

Antiplatelet

Antiplatelet

Antiplatelet

Introduction

COX inhibitor

ADP Receptor Antagonist - Thienopyridine

ADP Receptor Antagonist - Thienopyridine

GP IIb/IIIA Inhibitor

GP IIb/IIIA Inhibitor

Legacy Cicm Level

Level 1

Level 3

Level 3

Level 3

Level 3

Main Action

Platelet inhibition

Platelet inhibition

Platelet inhibition

Platelet inhibition

Platelet inhibition