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Ticagrelor is Associated with Increased Rosuvastatin Blood Concentrations in Patients who have had a Myocardial

Tjaša Dermota1,2, Borut Jug3, Jurij Trontelj4

  • 1University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia. tjasa.dermota@kclj.si.

Clinical Pharmacokinetics
|March 3, 2025
PubMed

Insights

Ticagrelor significantly increases rosuvastatin plasma concentrations approximately twofold in myocardial infarction patients. This pharmacokinetic interaction, independent of other factors, highlights potential clinical relevance for statin therapy management.

Area of Science:

  • Pharmacology and Clinical Pharmacy
  • Cardiovascular Medicine
  • Drug Interactions

Background:

  • High-dose rosuvastatin is crucial for post-myocardial infarction (MI) care.
  • P2Y12 inhibitors like ticagrelor are standard therapy after MI.
  • Potential drug interactions impacting statin efficacy require investigation.

Purpose of the Study:

  • To evaluate the effect of ticagrelor on rosuvastatin plasma concentrations.
  • To compare rosuvastatin levels in patients on ticagrelor versus other P2Y12 inhibitors (prasugrel, clopidogrel).

Main Methods:

  • 93 post-MI patients on rosuvastatin 40 mg/day and a P2Y12 inhibitor were studied.
  • Liquid chromatography-tandem mass spectrometry (LC-MS/MS) measured rosuvastatin concentrations.
  • Concomitant use of ticagrelor, prasugrel, or clopidogrel was assessed.

Main Results:

  • Rosuvastatin concentrations were ~2x higher with ticagrelor (9.7 ng/mL) vs. prasugrel (5.1 ng/mL) or clopidogrel (5.0 ng/mL).
  • Ticagrelor was an independent factor influencing rosuvastatin levels (p<0.001).
  • Elevated creatinine levels also correlated with higher rosuvastatin concentrations (p=0.039).

Conclusions:

  • A significant pharmacokinetic interaction exists between ticagrelor and rosuvastatin.
  • Concomitant ticagrelor use leads to approximately doubled rosuvastatin plasma concentrations.
  • This interaction has potential clinical implications for statin therapy management in post-MI patients.
Abstract

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