09-02-2020, 10:31 AM
Severe central apnea as side effect of Brilinta
Have been using CPAP (ResMed S9 Autoset, pressure=4) for moderate obstructive sleep apnea for eight years, with reasonably decent control (AHI <5). The CPAP does induce mild central apnea in me, but total AHI <5.
On 05/17/20 started taking an anti-platelet drug, Brilinta (ticagrelor, 90mg b.i.d.), to prevent blood clots post-MI and placement of a stent. Three nights later I experienced severe sleep apnea (AHI >20), all of it as central apnea. The following night I changed the machine's setting from CPAP at a set pressure of 4, to APAP with a maximum pressure of 10. I thought this would allow the machine to determine the correct pressure response. Instead, I was dangerously pressure over-driven during the night, and the central apnea continued unabated. Woke up dazed, mouth open slack, feeling on beyond horrible. Realized that (for me) this severe central sleep apnea could not be resolved with CPAP or APAP. Returned to CPAP at set pressure=4.8. Reduced dosage of Brilinta to 60mg b.i.d., and the central sleep apnea began to decline, resolving in about three weeks.
Central sleep apnea is an uncommon side effect of Brilinta, not listed on the package insert. There are a few case reports in the medical journals. Had I not been on CPAP therapy with a device capable of reporting the types of apnea events, I would have never recognized what was happening. That level of central apnea could have resulted in severe cardiac complications. The failure of the APAP algorithm to find a correct pressure compounded the hazard.
Hope this report alerts readers to an unusual drug hazard, and guides toward a safe resolution. Could any readers advise on why APAP resulted in being pressure over-driven? And on how one might have responded better? Offered with thanks for the collective knowledge of this community.
On 05/17/20 started taking an anti-platelet drug, Brilinta (ticagrelor, 90mg b.i.d.), to prevent blood clots post-MI and placement of a stent. Three nights later I experienced severe sleep apnea (AHI >20), all of it as central apnea. The following night I changed the machine's setting from CPAP at a set pressure of 4, to APAP with a maximum pressure of 10. I thought this would allow the machine to determine the correct pressure response. Instead, I was dangerously pressure over-driven during the night, and the central apnea continued unabated. Woke up dazed, mouth open slack, feeling on beyond horrible. Realized that (for me) this severe central sleep apnea could not be resolved with CPAP or APAP. Returned to CPAP at set pressure=4.8. Reduced dosage of Brilinta to 60mg b.i.d., and the central sleep apnea began to decline, resolving in about three weeks.
Central sleep apnea is an uncommon side effect of Brilinta, not listed on the package insert. There are a few case reports in the medical journals. Had I not been on CPAP therapy with a device capable of reporting the types of apnea events, I would have never recognized what was happening. That level of central apnea could have resulted in severe cardiac complications. The failure of the APAP algorithm to find a correct pressure compounded the hazard.
Hope this report alerts readers to an unusual drug hazard, and guides toward a safe resolution. Could any readers advise on why APAP resulted in being pressure over-driven? And on how one might have responded better? Offered with thanks for the collective knowledge of this community.
