University of Hertfordshire

From the same journal

By the same authors

  • Joanna Sikora
  • Malwina Barańska
  • Katarzyna Buszko
  • Natalia Skibińska
  • Wiktor Stroka
  • Krzysztof Pstrągowski
  • Jolanta M Siller-Matula
  • Jilma Bernd
  • Diana Gorog
  • Eliano P Navarese
  • Michał P Marszałł
  • Jacek Kubica
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Original languageEnglish
Pages (from-to)2126-2133
Number of pages7
JournalThrombosis and haemostasis
Early online date19 Nov 2018
Publication statusE-pub ahead of print - 19 Nov 2018


Extensive search for methods of overcoming morphine-related delay of the absorption and onset of action of oral P2Y12 inhibitors in patients presenting with acute coronary syndrome is on-going. The aim of the trial was to investigate whether metoclopramide co-administration could reduce this delay and improve the pharmacokinetics (PKs) and pharmacodynamics (PDs) of ticagrelor and its active metabolite AR-C124900XX. Plasma concentration of both compounds and platelet reactivity were evaluated in nine pre-defined time points within 6 hours after administration of ticagrelor loading dose. The results of our study show that mean platelet activity within the first hour was noticeably higher in metoclopramide-naive patients. Moreover, ticagrelor mean plasma concentration was significantly higher within the initial four time points (15, 30, 45, 60 minutes) in patients receiving metoclopramide (p = 0.039; p = 0.009; p = 0.005; p = 0.008, respectively). To conclude, the co-administration of metoclopramide in patients presenting with unstable angina and treated with morphine, has a beneficial effect on the PK/PD profile of ticagrelor and its metabolite; however, its impact on ST-elevation myocardial infarction patients requires further investigation.


© 2018 Georg Thieme Verlag KG

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