You have been prescribed Ticlid (pronounced Tie-clid) by your doctor. Reading this information can help you learn about Ticlid and how to make this medicine work best for you. If you have any questions after reading this information, speak with your doctor or pharmacist.

What is Ticlid?

Ticlid is a product name for the prescription drug ticlopidine. Each film-coated tablet of Ticlid contains 250 mg of ticlopidine hydrochloride, the active ingredient. It also contains additional (nonmedicinal or inactive) ingredients. These are: citric acid, cornstarch, hydroxypropylmethylcellulose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, povidone, stearic acid titanium dioxide and FD&C Blue #1 aluminum lake. Ticlopidine reduces the ability of blood clotting cells (platelets) to stick to each other and to the walls of blood vessels. This action reduces the tendency of blood to clot in unwanted places such as in narrowed blood vessels.

What is Ticlid used for?

Ticlid is usually prescribed to patients who have had a previous stroke or who have experienced one or more warning episodes indicating an increased risk of stroke, such as transient ischemic attacks, ischemic neurological changes or minor strokes. A stroke occurs when a clot (or thrombus) forms in a blood vessel in the brain, or forms in another part of the body and breaks off and then travels to the brain (embolus). In clinical trials, Ticlid has been shown to decrease both the stroke mortality and the occurrence of first or repeat stroke in such patients.

What should you tell your doctor before you start taking Ticlid?

Before beginning treatment with Ticlid, make sure your doctor knows if:

• you have ever had a bad reaction to Ticlid or any of its inactive ingredients
  
• you have a history of blood disorders such as low white blood cell counts (neutropenia), low platelets (thrombocytopenia) or lack of white blood cells (agranulocytosis)
  
• you have active bleeding problems such as stomach or intestinal ulcers, intracranial (within the head) bleeding
  
• you have severe liver disease
  
• you are pregnant, plan on becoming pregnant, or are breast-feeding a child
  
• you are taking any other medicines (including those not prescribed by your doctor). Ticlid is known to interfere with some other drugs.
  

This information will help your doctor and you decide whether you should use Ticlid, and what extra care may need to be taken while you are on the medication.

How should Ticlid be taken?

Your doctor has prescribed Ticlid after carefully studying your case. Other people may not benefit from taking this medicine, even though their problems may seem similar to yours. Do not give your Ticlid to anyone else.

Ticlid is intended for oral use only. The usual dosage is 2 tablets daily with meals throughout the course of treatment.

Ticlid has been prescribed to you to be used strictly as directed by your doctor. As certain adverse reactions may occur in some patients (see below), you will have to be carefully monitored by your doctor for their signs and symptoms especially for the first 3 months you are on Ticlid. You will also be required to have a blood test (to measure your blood count and some biochemical indicators) before you start taking Ticlid and then every 2 weeks for the first 3 months you are on Ticlid. If you stop taking Ticlid for any reason within the first 3 months, you will still need to have your blood tested for an additional 2 weeks after you have stopped taking Ticlid.

It is also very important that you report to your doctor immediately if you notice:

• any sign of infection such as fever, chills, sore throat, ulcers in the mouth, etc.
  
• abnormal bleeding and bruising or dark stool
  
• signs of jaundice (yellow eyes or skin, dark urine or light coloured stool)
  
• signs of fever, weakness, difficulty speaking or seizures
  
• skin rash
  
• persistent diarrhea
  

If your doctor is not immediately available, discontinue the medication until he/she can be consulted.

If you are to have any surgery or dental extraction, inform the surgeon or dentist that you are on Ticlid, which may cause prolonged bleeding.

Taking other medicines: Ticlid may alter your response to some medications; therefore, you should tell your doctor if you are presently taking any other medications. Your doctor will determine whether medications should be discontinued or if close monitoring or adjustments to the dosage or schedule are necessary. In particular, inform your doctor if you are taking any of the following medications: heparins, oral anticoagulants, antiplatelet drugs, nonsteroidal anti-inflammatory drugs or ASA and derivatives, theophylline, digoxin, phenobarbital, phenytoin or cyclosporine.

Side Effects

About 20% of patients will experience some side effects caused by Ticlid. Most side effects develop during the first 3 months of treatment and they usually disappear within 1 to 2 weeks after Ticlid is stopped. The potentially more serious adverse reactions are the following:

• Decreased white blood count occurs in about 2% of patients on Ticlid treatment. This condition will cause reduced resistance to infection. Regular blood tests are necessary to detect this side effect early and stop the medication. In less than 1% of patients, the white blood count can drop to very low levels, but discontinuation of Ticlid therapy will almost always result in complete recovery.
  
• Thrombotic thrombocytopenic purpura can occur in some patients taking Ticlid and can be sometimes associated with serious consequences. It is characterized by a large fall in platelet count, anemia, central nervous system (neurologic) changes, kidney dysfunction and fever.
  
• Increased bleeding tendency manifested by prolonged bleeding from traumatic or surgical wounds, bruising, bleeding into the gastrointestinal tract (manifested by black stool), etc. occurs rarely, in less than 1% of patients, but has to be watched for if you have a history of bleeding disorders, gastroduodenal ulcers, etc. (discuss your medical history with your physician), or if you are about to have a surgical procedure (do not forget to inform the surgeon or dentist).
  
• Very rarely jaundice and/or liver failure, usually reversible upon withdrawal of Ticlid, have been reported.
  

More common side effects are upset stomach (to minimize this possibility, always take Ticlid with meals), diarrhea, and skin rashes.

Your doctor may wish to do routine blood tests from time to time as Ticlid may alter blood counts, blood flow (hemostasis) or liver tests.

As with any drug, the possibility of an unexpected, previously unknown, potentially serious adverse reaction can never be ruled out. Report any other undesirable or unpleasant effects not mentioned in this leaflet to your doctor.

In Case of Accidental Overdose

Contact your doctor and/or Poison Control Centre immediately if you suspect you have taken an overdose or someone else accidentally takes your Ticlid. If you are unable to contact them, go to a hospital emergency department for medical help.

Storage

• Keep out of the reach of children.
  
• Store at room temperature (15 to 30°C). Protect from light.
  
• Do not use this medicine after the expiry date on the package.
  

Warning: Use only as directed.

This insert does not provide all known information about Ticlid. If you do not understand this information, or have any questions or concerns about your treatment, please speak with your doctor or pharmacist.