Ticagrelor Administration Timing
Ticagrelor can be taken with or without food, as food intake has minimal clinical impact on its efficacy and safety. 1
Evidence-Based Rationale
The pharmacokinetic data demonstrates that food effects on ticagrelor are clinically insignificant:
Time to peak concentration (Tmax) is slightly delayed with food (2.5 hours vs 1.5 hours fasting), but this delay does not affect clinical outcomes 1
Maximum concentration (Cmax) remains comparable between fed and fasting states, with the 95% confidence interval (0.85-1.03) falling within the predefined no-effect limits of 0.80-1.25 1
Area under the curve (AUC) is only 21% higher with food intake compared to fasting, which is considered of minimal clinical significance 1
Active metabolite (AR-C124910XX) exposure is unaffected by food, with AUC showing a 95% CI of 0.93-1.07 1
Clinical Practice Implications
The flexibility of administration timing allows for optimal patient compliance, which is particularly important given that adherence issues are a known concern with ticagrelor therapy 2
Dosing Recommendations Regardless of Food Intake:
Loading dose: 180 mg given as early as possible before or at the time of PCI for UA/NSTEMI patients 2
Maintenance dose: 90 mg twice daily for at least 12 months post-ACS 2
Aspirin co-administration: Must be limited to 81-100 mg daily, as higher doses paradoxically decrease ticagrelor effectiveness 2
Practical Considerations
Advise patients to take ticagrelor at consistent times each day (morning and evening) to maintain steady antiplatelet effects, regardless of meal timing. 1 This approach maximizes adherence while ensuring therapeutic efficacy.
The bioequivalence studies in Chinese populations confirmed these findings, demonstrating similar pharmacokinetic and safety profiles with or without food intake 3