1. Oral NAloxone to overcome the moRphine effect in acute COronary syndrome patients treated with TICagrelor — NARCOTIC trial
- Author
-
Przemysław Sobczak, Bernd Jilma, Malwina Barańska, Piotr Niezgoda, Michał Piotr Marszałł, Katarzyna Buszko, Eliano Pio Navarese, Joanna Sikora, Adam Sikora, and Jacek Kubica
- Subjects
Narcotics ,Ticagrelor ,medicine.medical_specialty ,Acute coronary syndrome ,Narcotic ,medicine.medical_treatment ,(+)-Naloxone ,030204 cardiovascular system & hematology ,Loading dose ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Acute Coronary Syndrome ,Morphine ,Naloxone ,business.industry ,Unstable angina ,General Medicine ,medicine.disease ,Pharmacodynamics ,Anesthesia ,Purinergic P2Y Receptor Antagonists ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Background: Numerous worldwide clinical trials have proven the indisputably negative influence of morphine on the pharmacokinetics and pharmacodynamics of P2Y 12 receptor inhibitors in patients presenting with acute coronary syndromes. The aim of this trial was to evaluate whether oral co-administration of an anti-opioid agent, naloxone, can be considered a successful approach to overcome ‘the morphine effect’. Methods: Consecutive unstable angina patients receiving ticagrelor and morphine with or without orally administered naloxone underwent assessment of platelet reactivity using Multiplate analyzer as well as evaluation of the pharmacokinetic profile of ticagrelor and its active metabolite, AR-C124910XX, at nine pre-defined time points within the first 6 hours following oral intake of the ticagrelor loading dose. Results: The trial shows no significant differences regarding the pharmacokinetics of ticagrelor between both study arms throughout the study period. AR-C124910XX plasma concentration was significantly higher 120 min after the ticagrelor loading dose administration (p = 0.0417). However, the evaluation of pharmacodynamics did not show any statistically significant differences between the study arms. Conclusions: To conclude, this trial shows that naloxone co-administration in ticagrelor-treated acute coronary syndrome patients on concomitant treatment with morphine shows no definite superiority in terms of ticagrelor pharmacokinetic and pharmacodynamic profile.
- Published
- 2022
- Full Text
- View/download PDF