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Background <p>Ticagrelor is widely used for acute coronary syndrome (ACS) and often co-administered with other drugs. However, the specific drug combinations that elevate the risk of potential drug-drug interaction (DDI) remain incompletely understood. We aimed to investigate DDI between ticagrelor and concomitant medications using the Food and Drug Administration Adverse Event Reporting System (FAERS) database.</p> Methods <p>We used six frequency statistical models to detect the DDI signals from January 2012 to June 2025: Ω shrinkage, chi-square statistic, proportional reporting ratio (PRR), concomitant signal score (CSS), additive model and multiplicative model. Hemorrhagic signals were further identified using reported odds ratio (ROR) and corroborated by these six models.</p> Results <p>After deduplication, 15,445,985 cases were included for analysis, 30,415 of which involved ticagrelor. A significant signal for rhabdomyolysis was detected when combining ticagrelor with statins. Among anticoagulants, heparin and enoxaparin demonstrated the most pronounced hemorrhagic signals. Additional signals included acute kidney injury and hematuria with ibuprofen, and dizziness with nitroglycerin. In a parallel analysis of prasugrel or clopidogrel, no rhabdomyolysis signal was detected for the statin combination, whereas hemorrhagic signals were observed when co-administered with anticoagulants. Compared with ticagrelor alone, concomitant therapies, especially with metoprolol might increase the risk of urinary tract bleeding.</p> Conclusions <p>The real-world analysis revealed the significant DDI signals involving ticagrelor. Concomitant use with statins or anticoagulants demonstrated a statistical association with rhabdomyolysis and hemorrhagic complications, respectively. Signals for renal injury, urinary tract bleeding, and injection site reactions were also identified with other co-administered drugs. These findings suggest that the risks and benefits of ticagrelor combination therapies should be carefully assessed.</p>

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Possible clinical drug interactions between ticagrelor and concomitant medications: for adverse drug event monitoring in real-world

  • 期刊论文

  • 发表日期：

    2026年4月21日

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  • Tianya Liu,
  • Zhuang Chen,
  • Rui Wang,
  • Xiaomei Xu,
  • Fang Gao,
  • Jie Zu,
  • Zhiping Wang,
  • Yiming Tian

摘要

Background

Ticagrelor is widely used for acute coronary syndrome (ACS) and often co-administered with other drugs. However, the specific drug combinations that elevate the risk of potential drug-drug interaction (DDI) remain incompletely understood. We aimed to investigate DDI between ticagrelor and concomitant medications using the Food and Drug Administration Adverse Event Reporting System (FAERS) database.

Methods

We used six frequency statistical models to detect the DDI signals from January 2012 to June 2025: Ω shrinkage, chi-square statistic, proportional reporting ratio (PRR), concomitant signal score (CSS), additive model and multiplicative model. Hemorrhagic signals were further identified using reported odds ratio (ROR) and corroborated by these six models.

Results

After deduplication, 15,445,985 cases were included for analysis, 30,415 of which involved ticagrelor. A significant signal for rhabdomyolysis was detected when combining ticagrelor with statins. Among anticoagulants, heparin and enoxaparin demonstrated the most pronounced hemorrhagic signals. Additional signals included acute kidney injury and hematuria with ibuprofen, and dizziness with nitroglycerin. In a parallel analysis of prasugrel or clopidogrel, no rhabdomyolysis signal was detected for the statin combination, whereas hemorrhagic signals were observed when co-administered with anticoagulants. Compared with ticagrelor alone, concomitant therapies, especially with metoprolol might increase the risk of urinary tract bleeding.

Conclusions

The real-world analysis revealed the significant DDI signals involving ticagrelor. Concomitant use with statins or anticoagulants demonstrated a statistical association with rhabdomyolysis and hemorrhagic complications, respectively. Signals for renal injury, urinary tract bleeding, and injection site reactions were also identified with other co-administered drugs. These findings suggest that the risks and benefits of ticagrelor combination therapies should be carefully assessed.