This article is more than 5 years old. Information may no longer be current.
IMPRESSION: Morphine renders ticagrelor less effective in acute MI
Click Here to Manage Email Alerts
Morphine appears to reduce the antiplatelet effect of ticagrelor and delay its action in patients with acute MI, according to results from the IMPRESSION trial.
Researchers randomly assigned 70 patients with acute MI at a single center to receive IV morphine 5 mg or placebo followed by ticagrelor (Brilinta, AstraZeneca) 180 mg to assess the influence of morphine on the pharmacokinetics and pharmacodynamics of ticagrelor. They assessed pharmacokinetics using liquid chromatography-tandem mass spectrometry and pharmacodynamics by as many as three platelet function tests.
Jacek Kubica, MD, PhD, from the department of cardiology and internal medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland, and colleagues found that morphine lowered the exposure to ticagrelor by 36% (area under the plasma concentration-time curve, 6,307 ng h/mL vs. 9,791 ng h/mL; P = .003).
Morphine also lowered exposure to the active metabolite of ticagrelor, AR-C124910XX, by 37% (area under the plasma concentration-time curve, 1,503 ng h/mL vs. 2,388 ng h/mL; P = .008), and was associated with a delay in maximal plasma concentration of ticagrelor (4 hours vs. 2 hours; P = .004).
Results from multiple regression analyses indicated that lower area under the plasma concentration-time curve values for ticagrelor were linked to morphine (P = .004) and presence of STEMI (P = .014).
In all three platelet function tests, the placebo group had a stronger antiplatelet effect and the morphine group had a higher rate of high platelet reactivity, according to the researchers.
“To our knowledge, the current trial is the first one to confirm the negative impact exerted by morphine on the pharmacokinetics and antiplatelet action of ticagrelor in [patients with acute MI] obtained in a randomized study,” Kubica and colleagues wrote. “Although we did not investigate the underlying mechanism of our findings in detail, it seems likely that morphine impairs absorption of ticagrelor.” ˗ by Erik Swain
Disclosure: Kubica reports consulting for AstraZeneca. Three other researchers report financial ties with AstraZeneca.
Click Here to Manage Email Alerts