No pharmaceutical opinion available for this interaction.
Ritonavir can inhibit the CYP 3A4 and P-gp and increase the plasma concentration of Ticagrelor.
Ritonavir can inhibit the metabolism (CYP 3A4) and decrease the active metabolite formation of Ticagrelor.
3A4 and 2D6 (major), 1A2 and 2B6 (minor), 5 metabolites, one of which has a weak concentration of an active metabolite (M-2), transporters: MRP1, MRP2, P-gp
2B6, 2C8, 2C9, 1A2, 2C19 (moderate) UGT (moderate)
3A4 (potent) and 2D6 (moderate), transporters: BCRP, OATP1A2, OATP1B1, OATP1B3, MRP1, MRP2, OCT1, OCT2, P-gp
3A4 and 3A5: Active metabolite that is similar in activity to ticagrelor; P-gp
3A4 (weak), P-gp (weak)
Possible increase of adverse effects.
Possible decrease of clinical efficacy.
Contraindicated. Use alternative.
Adverse effects of ticagrelor: Bleeding (epistaxis, gastrointestinal/cutaneous hemorrhage), bruising, dyspnea, headache, dizziness, gastrointestinal effects (nausea, vomiting, dyspepsia, diarrhea or constipation), bradycardia.
Ref #3164 : An in vitro study with healthy volunteers showed that ketoconazole, a potent inhibitor of CYP3A4, increased ticagrelor AUC by more than 7.3-fold and Cmax by 2.4-fold and decreased the active metabolite AUC and Cmax by 56% and 89%, respectively.