The Drug-Induced Respiratory Disease Website and App

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

IX.h

Dyspnea, unexplained otherwise

May lead to ED visit (PMID 29601310)

Publications

Liu R, Xiao L, Yan Q, Liu X

Safety profile of ticagrelor: an analysis based on literature and database review.

BMC cardiovascular disorders. 2026;26(1)

Angiolillo DJ, Cao D, Sartori S, Baber U, Dangas G, Zhang Z, Vogel B, Kunadian V, Briguori C, Cohen DJ, Collier T, Dudek D, Gibson M, Gil R, Huber K, Kaul U, Kornowski R, Krucoff MW, Ielasi A, Stefanini GG, Pivato CA, Mehta S, Moliterno DJ, Ohman EM, Esca

Dyspnea-Related Ticagrelor Discontinuation After Percutaneous Coronary Intervention.

JACC. Cardiovascular interventions. 2023;16(20):2514-2524

Sanmartin-Fernandez M, Zamorano JL

Theophylline for Attenuating Ticagrelor-Related Dyspnea.

Arquivos brasileiros de cardiologia. 2021;117(1):146-148

Di Filippo C, Caniato F, Cappelli F, Mattesini A, Meucci F, Sori A, Stolcova M, Agostini C, Bernardo P, Di Mario C

Discontinuation of both cangrelor and ticagrelor because of severe dyspnea during primary angioplasty.

Journal of cardiovascular medicine (Hagerstown, Md.). 2021;22(4):317-319

Zhang N, Xu W, Li O, Zhang B

The risk of dyspnea in patients treated with third-generation P2Y(12) inhibitors compared with clopidogrel: a meta-analysis of randomized controlled trials.

BMC cardiovascular disorders. 2020;20(1):140

Tomaniak M, Chichareon P, Takahashi K, Kogame N, Modolo R, Chang CC, Spitzer E, Neumann FJ, Plante S, Hernández Antolin R, Jambrik Z, Gelev V, Brunel P, Konteva M, Beygui F, Morelle JF, Filipiak KJ, van Geuns RJ, Soliman O, Tijssen J, Rademaker-Havinga T,

Impact of chronic obstructive pulmonary disease and dyspnoea on clinical outcomes in ticagrelor treated patients undergoing percutaneous coronary intervention in the randomized GLOBAL LEADERS trial.

European heart journal. Cardiovascular pharmacotherapy. 2020;6(4):222-230

Steg PG, Bhatt DL, Simon T, Fox K, Mehta SR, Harrington RA, Held C, Andersson M, Himmelmann A, Ridderstråle W, Leonsson-Zachrisson M, Liu Y, Opolski G, Zateyshchikov D, Ge J, Nicolau JC, Corbalán R, Cornel JH, Widimský P, Leiter LA, THEMIS Steering Commit

Ticagrelor in Patients with Stable Coronary Disease and Diabetes.

The New England journal of medicine. 2019;381(14):1309-1320

Wang D, Yang XH, Zhang JD, Li RB, Jia M, Cui XR

Compared efficacy of clopidogrel and ticagrelor in treating acute coronary syndrome: a meta-analysis.

BMC cardiovascular disorders. 2018;18(1):217

Lombardi N, Lucenteforte E, Torrini M, Balzi D, Barchielli A, Mugelli A, Vannacci A

Ticagrelor-related late-onset dyspnea as cause of emergency department visit: a 3-year outpatient study.

Journal of cardiovascular medicine (Hagerstown, Md.). 2018;19(6):284-289

Alexopoulos D, Xanthopoulou I, Perperis A, Goudevenos J, Hamilos M, Sitafidis G, Kanakakis I, Vavouranakis M, Giannopoulos G, Barampoutis N, Deftereos S, Lekakis J

Dyspnea in patients treated with P2Y(12) receptor antagonists: insights from the GReek AntiPlatElet (GRAPE) registry.

Platelets. 2017;28(7):691-697

Minner SA, Simone P, Chung BB, Shah AP

Successful Reversal of Bradycardia and Dyspnea With Aminophylline After Ticagrelor Load.

Journal of pharmacy practice. 2018;31(1):112-114

Bonaca MP, Bhatt DL, Oude Ophuis T, Steg PG, Storey R, Cohen M, Kuder J, Im K, Magnani G, Budaj A, Theroux P, Hamm C, Špinar J, Kiss RG, Dalby AJ, Medina FA, Kontny F, Aylward PE, Jensen EC, Held P, Braunwald E, Sabatine MS

Long-term Tolerability of Ticagrelor for the Secondary Prevention of Major Adverse Cardiovascular Events: A Secondary Analysis of the PEGASUS-TIMI 54 Trial.

JAMA cardiology. 2016;1(4):425-32

Andell P, James SK, Cannon CP, Cyr DD, Himmelmann A, Husted S, Keltai M, Koul S, Santoso A, Steg PG, Storey RF, Wallentin L, Erlinge D, PLATO Investigators

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and Chronic Obstructive Pulmonary Disease: An Analysis From the Platelet Inhibition and Patient Outcomes (PLATO) Trial.

Journal of the American Heart Association. 2015;4(10):e002490

Lindholm D, Storey RF, Christersson C, Halvorsen S, Grove EL, Braun OÖ, Varenhorst C, James SK

Design and rationale of TROCADERO: A TRial Of Caffeine to Alleviate DyspnEa Related to ticagrelOr.

American heart journal. 2015;170(3):465-70

Sánchez-Galian MJ, Flores-Blanco PJ, López-Cuenca A, Gómez-Molina M, Guerrero-Pérez E, Cambronero-Sánchez F, Sánchez-Martínez M, Valdés M, Manzano-Fernández S

Ticagrelor related dyspnea in patients with acute coronary syndromes: Incidence and implication on ticagrelor withdrawn.

International journal of cardiology. 2015;187:517-8

Bonaca MP, Bhatt DL, Cohen M, Steg PG, Storey RF, Jensen EC, Magnani G, Bansilal S, Fish MP, Im K, Bengtsson O, Oude Ophuis T, Budaj A, Theroux P, Ruda M, Hamm C, Goto S, Spinar J, Nicolau JC, Kiss RG, Murphy SA, Wiviott SD, Held P, Braunwald E, Sabatine

Long-term use of ticagrelor in patients with prior myocardial infarction.

The New England journal of medicine. 2015;372(19):1791-800

Lombardi N, Lenti MC, Matucci R, Mugelli A, Vannacci A

Ticagrelor-related dyspnea: an underestimated and poorly managed event?

International journal of cardiology. 2015;179:238-9

Gaubert M, Laine M, Richard T, Fournier N, Gramond C, Bessereau J, Mokrani Z, Bultez B, Chelini V, Barnay P, Maillard L, Paganelli F, Bonello L

Effect of ticagrelor-related dyspnea on compliance with therapy in acute coronary syndrome patients.

International journal of cardiology. 2014;173(1):120-1

Belchikov YG, Koenig SJ, Dipasquale EM

Potential role of endogenous adenosine in ticagrelor-induced dyspnea.

Pharmacotherapy. 2013;33(8):882-7

Cattaneo M, Faioni EM

Why does ticagrelor induce dyspnea?

Thrombosis and haemostasis. 2012;108(6):1031-6

Schrör K

'Reversible nature of platelet binding causing transfusion-related acute lung injury (TRALI) syndrome may explain dyspnea after ticagrelor and elinogrel' - a hypothesis that remains unproven.

Thrombosis and haemostasis. 2012;108(6):1028-30

Serebruany VL

Viewpoint: reversible nature of platelet binding causing transfusion-related acute lung injury (TRALI) syndrome may explain dyspnea after ticagrelor and elinogrel.

Thrombosis and haemostasis. 2012;108(6):1024-7

Storey RF, Becker RC, Harrington RA, Husted S, James SK, Cools F, Steg PG, Khurmi NS, Emanuelsson H, Cooper A, Cairns R, Cannon CP, Wallentin L

Characterization of dyspnoea in PLATO study patients treated with ticagrelor or clopidogrel and its association with clinical outcomes.

European heart journal. 2011;32(23):2945-53

Storey RF, Bliden KP, Patil SB, Karunakaran A, Ecob R, Butler K, Teng R, Wei C, Tantry US, Gurbel PA, ONSET/OFFSET Investigators

Incidence of dyspnea and assessment of cardiac and pulmonary function in patients with stable coronary artery disease receiving ticagrelor, clopidogrel, or placebo in the ONSET/OFFSET study.

Journal of the American College of Cardiology. 2010;56(3):185-93

Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, PLATO Investigators, Freij A, Thorsén M

Ticagrelor versus clopidogrel in patients with acute coronary syndromes.

The New England journal of medicine. 2009;361(11):1045-57

Husted S, van Giezen JJ

Ticagrelor: the first reversibly binding oral P2Y12 receptor antagonist.

Cardiovascular therapeutics. 2009;27(4):259-74