Ticagrelor

Brilinta

Brilinta (Ticagrelor) is an FDA-approved medication to reduce the risk of serious cardiovascular events such as heart attacks, strokes, and death due to heart complications, particularly in adults. Brilinta contains ticagrelor, which is the active ingredient in the medication, and it is part of a group of drugs known as antiplatelets. It works as an antiplatelet drug by preventing blood clots and is taken orally in tablet form, typically twice a day, alongside low-dose aspirin. It’s available in 60 mg and 90 mg dosages, with specific regimens based on the patient’s condition. This medication is available exclusively as a brand-name drug. Critical side effects include increased bruising, shortness of breath, and potential severe bleeding. Usage should be closely monitored by a healthcare provider, mainly due to its interactions with other medications.

Product Overview

Brilinta, known generically as Ticagrelor, is an antiplatelet medication used primarily to prevent serious cardiovascular issues in adults, including heart attacks, strokes, and related deaths. It’s particularly prescribed for patients with a history of cardiovascular diseases or those who have undergone procedures like stent placement. The medication inhibits platelets from clumping together, thus reducing the likelihood of forming dangerous blood clots.

Administered orally, Brilinta is available in two strengths: 60 mg and 90 mg tablets, with the dosage varying based on the medical condition and treatment phase. Initially, a higher loading dose is used to rapidly elevate drug levels in the body, followed by a regular maintenance dose. It is essential to take Brilinta alongside aspirin, typically 75 to 100 mg daily, to enhance its efficacy. While Brilinta is effective in preventing thrombotic events, it does carry risks of side effects. Common issues include more frequent bruising and mild shortness of breath. However, it may also cause severe bleeding, which necessitates immediate medical attention. Other significant adverse effects include dyspnea and potential bradyarrhythmias. 

Drug interactions are noteworthy with Brilinta, especially with NSAIDs like ibuprofen, certain antifungal and antiviral medications, and drugs that affect heart rhythm, such as digoxin. These interactions can either increase the risk of side effects or diminish the effectiveness of the medication. Given these factors, Brilinta treatment requires careful management and consultation with healthcare professionals to tailor the therapy to individual patient needs, considering both the benefits and potential risks.

Uses of Brilinta

Brilinta is prescribed for:

• Reducing the risk of serious cardiovascular issues in adults. These issues can include heart attacks, strokes, and death due to heart-related problems.
• Preventing blood clots in individuals with acute coronary syndrome (ACS) who have had a stent placed in their heart’s blood vessels.
• Reducing the likelihood of heart attacks and strokes in people who have not previously experienced these conditions.
• Managing stroke risks in those who are either experiencing a stroke caused by a blocked vessel or a transient ischemic attack (TIA).

How to Use Brilinta?

Dosage

It comes in the form of a tablet that is taken by mouth twice a day, and it should be used in combination with aspirin. It comes in two strengths: 

• Brilinta 60 mg tablet
• Brilinta 90 mg tablet

Recommended Dosage for Different Patients

Dosage for Preventing Cardiovascular Events

Brilinta is prescribed to reduce the risk of cardiovascular events such as heart attacks or strokes, especially in individuals with acute coronary syndrome (ACS) or those who have a history of heart attacks. Here is how Brilinta is typically dosed:

• First Day of Treatment: You will start with a one-time loading dose of 180 mg. This initial high dose helps to quickly establish an adequate level of the medication in your body.
• First Year of Treatment: After the initial loading dose, you will take 90 mg of Brilinta twice daily for one year.
• Second Year and Beyond: Starting from the second year of treatment, the dosage will be reduced to 60 mg, taken twice daily. You will continue with this dosage as long as your doctor recommends.

Brilinta is taken alongside aspirin each day to enhance its effectiveness. The recommended daily dose of aspirin to be taken with Brilinta is between 75 mg and 100 mg. Always follow your doctor’s instructions regarding medication to ensure safety and effectiveness in preventing heart-related health events.

Dosage for Preventing Blood Clots After Stent Placement

Brilinta is prescribed to prevent blood clots in individuals with acute coronary syndrome (ACS) who have undergone stent placement. Here’s the recommended dosage plan for such cases:

• Initial Treatment: On the first day, you will take a one-time loading dose of 180 mg. This higher initial dose ensures that the medication starts working effectively right away.
• First Year of Treatment: Following the loading dose, you should take 90 mg of Brilinta twice daily for one year.
• Subsequent Years: From the second year of treatment onwards, the dosage is reduced to 60 mg, taken twice daily. You should continue this regimen as long as it is recommended by your doctor.

Aspirin is also recommended in combination with Brilinta, typically 75 mg to 100 mg. Always follow your doctor’s guidance regarding using these medications to optimize your treatment and prevent complications.

Dosage for Preventing Heart Attack and Stroke

Brilinta is used to prevent heart attacks and strokes in individuals diagnosed with coronary artery disease (CAD) who are at a higher risk but have not previously had a heart attack or stroke. Here is the recommended dosage:

• Ongoing Treatment: The standard dosage is 60 mg of Brilinta, taken twice daily. Continue this dosage for as long as your doctor prescribes.
• Combination with Aspirin: It is essential to take Brilinta in conjunction with aspirin each day. The advised daily aspirin dosage when used with Brilinta is between 75 mg and 100 mg.

Dosage for Preventing Stroke

Brilinta is prescribed for individuals experiencing a stroke due to a blocked blood vessel or a transient ischemic attack (TIA). Here’s the standard dosing protocol:

• • Initial Treatment: On the first day, you’ll receive a one-time loading dose of 180 mg. This higher dose ensures that the medication begins to work effectively and immediately.
  • Continuing Dosage: After the loading dose, you should take 90 mg of Brilinta twice daily for up to 30 days.

• Combination with Aspirin:

• • Loading Dose of Aspirin: On the first day, along with the initial dose of Brilinta, a loading dose of aspirin between 300 mg and 325 mg is recommended.
  • Maintenance Dose of Aspirin: Subsequently, the daily aspirin dosage should be between 75 mg and 100 mg.

[Note: These recommendations may vary from person to person. Discuss them with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

• You should take Brilinta twice a day. It can be taken with or without food, depending on your preference.
• For optimal effectiveness, try to take your doses of Brilinta approximately 12 hours apart. 
• Maintaining a routine, such as taking the medication in the morning and evening, can help keep the drug levels consistent in your body.
• If you find it difficult to swallow tablets, there are strategies that might help, which you can find in this article. Additionally, discussing with your doctor or pharmacist is advisable for further guidance on how to take the medication effectively.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Brilinta Work?

Brilinta is known generically as ticagrelor and is commonly used alongside low-dose aspirin to help prevent heart attacks and strokes in people who have a history of heart disease or stroke or who are at increased risk for these conditions due to factors like diabetes or a history of transient ischemic attack (TIA). It is also used to prevent blood clots after certain heart surgeries, such as the placement of a stent. Ticagrelor is classified as an antiplatelet drug. It works by preventing platelets in your blood from clumping together to form harmful clots. This action helps to keep the blood flowing smoothly through your body, reducing the risk of severe cardiovascular events.

Important Safety Information

Side Effects

Common side effects of Brilinta may include:

• Bruising more often than usual
• Shortness of breath

Mild side effects of Brilinta may include:

• Dizziness 
• Diarrhea
• Mild allergic reaction

Serious side effects of Brilinta may include:

• Abnormal Bradycardia (Slow Heart Rate)
• Major bleeding may require immediate medical attention. Symptoms of significant bleeding include:
  • Any uncontrolled bleeding from any part of the body.
  • Urine that appears pink, red, or brown.
  • Coughing up blood or expelling phlegm that is black, resembling coffee grounds.
  • Stools that are red or black in color.

Mild allergic reactions of Brilinta may include:

• Itchiness
• Skin rash
• Flushing, which provides for redness and warmth of your skin

Severe allergic reactions of Brilinta may include:

• Swelling of the mouth, tongue, or throat, which can lead to difficulty breathing or speaking
• Swelling under the skin, often seen in areas like the hands, feet, eyelids, or lips

Although rare, a severe allergic reaction is possible. If you experience any signs of a severe allergic reaction to Brilinta, it is critical to contact your doctor immediately.

[Note: Remember, this list may not cover all possible side effects. If the symptoms appear life-threatening or if you think you are having a medical emergency, call 911 right away.]

Warnings

• Concomitant Aspirin Maintenance Dose: It is advised to use Brilinta with a maintenance dose of aspirin between 75 mg and 100 mg. Higher doses of aspirin above 100 mg after the initial loading dose may reduce the effectiveness of Brilinta.
• Dyspnea (Difficulty Breathing): Approximately 14% of patients taking Brilinta may experience dyspnea, which is generally mild to moderate and often resolves on its own during continued treatment. However, a small percentage of patients find the symptom intolerable and may need to stop using Brilinta. If dyspnea is new, prolonged, or worsens and is related to Brilinta, continued treatment without interruption is usually possible unless the symptom is intolerable.
• Discontinuation of Brilinta: Stopping Brilinta can significantly increase the risk of a heart attack, stroke, and death. If it is necessary to stop Brilinta temporarily, for example, to manage bleeding or before major surgery, it should be restarted as soon as it is safe to do so. In cases where surgery involves a significant risk of bleeding, Brilinta should ideally be stopped five days prior to the procedure and resumed once hemostasis is achieved.
• Bradyarrhythmias (Slow Heart Rhythms): Brilinta can cause slow heart rhythms, such as ventricular pauses and AV block. These conditions have been noted after the drug was approved for use. Patients with a history of certain heart rhythm disorders (like sick sinus syndrome or severe AV block) who do not have a pacemaker may face an increased risk of developing bradyarrhythmias while taking Brilinta.
• Alcohol Consumption: While there is no direct interaction identified between alcohol and Brilinta, it is important to consider the effects of heavy drinking. Consuming large amounts of alcohol can irritate the stomach lining and increase the risk of developing bleeding ulcers. Since Brilinta itself can cause bleeding as a side effect, drinking alcohol while on this medication may further heighten your risk of bleeding. Discuss with your doctor the safe amount of alcohol you can consume while taking Brilinta, if any.

Boxed Warning

Risk of Bleeding: Brilinta has a boxed warning, which is the most serious type of warning issued by the Food and Drug Administration (FDA). This warning highlights the significant risks associated with bleeding and the use of aspirin in conjunction with Brilinta. These risks are serious and require careful consideration. It is important to discuss these risks with your doctor to fully understand the implications of taking aspirin while being treated with Brilinta.

Precautions

Before starting Brilinta, it is crucial to discuss your medical history with your doctor. Brilinta may not be suitable if you have certain health conditions or factors that could interact negatively with the drug. Here are specific conditions and factors to consider:

• Active Bleeding: If you are currently experiencing serious bleeding, such as bleeding in your brain or from a bleeding ulcer, Brilinta is likely not appropriate for you. The drug can increase the risk of bleeding.
• History of Brain Bleeding: If you have had bleeding in your brain in the past, Brilinta may increase your risk of bleeding problems. Make sure to inform your doctor about this history; they will likely recommend a different treatment option for your condition.
• Heart Rate Problems: Brilinta may cause your heart rate to slow down. If you already have issues with a slow heart rate, Brilinta could exacerbate this problem. It’s important to inform your doctor about any heart rate issues you have experienced or if you are currently taking medications to manage your heart rate. Your doctor will assess whether Brilinta is a safe option for you.
• Breathing Problems: Brilinta has been known to cause breathing difficulties, including shortness of breath. If you have respiratory conditions like asthma or chronic obstructive pulmonary disease (COPD), taking Brilinta might worsen these conditions. Discuss with your doctor to determine if Brilinta is suitable for your medical needs.
• Liver Problems: If you have significant liver issues, such as cirrhosis, your body may not be able to process Brilinta effectively. This can result in higher levels of Brilinta in your bloodstream, increasing your risk of bleeding. It’s important to inform your doctor about any liver problems you have. They will likely recommend a different medication that is safer for your condition.
• Allergic Reactions: If you have previously experienced an allergic reaction to Brilinta or any of its components, your doctor will probably advise against using this medication. Be sure to discuss alternative treatments with your doctor that might be more suitable for your health needs.

Other Important Precautions

Pregnancy: The safety of Brilinta during pregnancy is not fully established. In animal studies, high doses of Brilinta were shown to harm the fetus, although these results do not always predict human outcomes. If you are pregnant or planning to become pregnant, it is crucial to consult with your doctor. They can assess whether Brilinta is the most appropriate medication for your condition during pregnancy.

Breastfeeding: Brilinta has been found to pass into breast milk in animal studies, which may pose a risk to a nursing infant. Due to these findings, it is generally recommended not to take Brilinta if you are breastfeeding. Discuss with your doctor potential safe alternatives for feeding your child if you need to take Brilinta.

Brilinta Contraindications

Do not take Brilinta if you:

• Have a history of intracranial hemorrhage.
• Are currently experiencing active bleeding
• Have allergies to ticagrelor or any ingredients in Brilinta

Missed Dose

• If you miss a dose of Brilinta, do not take an extra dose to catch up. Simply wait and take your next scheduled dose at the regular time. Taking an additional dose can increase your risk of serious bleeding.
• To ensure you don’t miss doses in the future, consider setting a reminder on your phone or using a medication timer. These tools can help you maintain your dosing schedule and get the full benefit of your treatment.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

Do not take more Brilinta than prescribed by your doctor, as it can cause serious health issues. If you take too much, you may experience the following symptoms:

• Nausea
• Excessive bleeding
• Vomiting
• Irregular heartbeat
• Diarrhea

If you suspect an overdose, contact your doctor immediately. Alternatively, you can call your nearest emergency number or contact the American Association of Poison Control Centers for assistance.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Storage

• Store ticagrelor (Brilinta) at room temperature, between 59°F and 86°F (15°C and 30°C).
• Keep the medication away from light and heat.
• Do not store Brilinta in moist or damp areas, such as bathrooms.

[Note: Discuss with your healthcare professional the proper disposal of unused medicine and any questions you may have regarding its storage.]

Brilinta Interactions

Brilinta can interact with various other medications and certain foods. These interactions can affect how well Brilinta works or escalate the severity of side effects. Each interaction may have a different impact, influencing the effectiveness of the medication or intensifying side effects.

Interactions with Other Medications

Below are some medications that can interact with Brilinta, but this is not a complete list. Before starting Brilinta, it’s important to discuss with your doctor and pharmacist all medications you are currently taking. This includes vitamins, over-the-counter medicines, herbs, prescription drugs, and supplements. Providing this information is crucial to prevent potential interactions. If you have any concerns about how other drugs might interact with Brilinta, don’t hesitate to ask your doctor or pharmacist for advice.

Ibuprofen: Combining Brilinta with ibuprofen (found in products like Advil and Motrin) can raise your risk of bleeding, particularly in the stomach. This increased risk is due to ibuprofen’s potential to cause stomach bleeding on its own, coupled with Brilinta’s general effect of enhancing bleeding risk. Consult your doctor to determine if it is safe for you to use ibuprofen while undergoing treatment with Brilinta.

Digoxin: Taking Brilinta with digoxin (Lanoxin), a medication used to manage heart rhythm, can increase the risk of severe side effects from digoxin. This occurs because Brilinta inhibits the breakdown of digoxin in your body, leading to higher levels of digoxin in your blood. If you need to take digoxin along with Brilinta, your doctor will regularly monitor your blood levels of digoxin. This monitoring is essential to help your doctor determine the safest dosage of digoxin for you.

Certain Antifungal Drugs: Using Brilinta in conjunction with certain antifungal medications can heighten your risk of experiencing Brilinta’s side effects, such as bleeding. This risk increase is due to certain antifungal drugs inhibiting the breakdown of Brilinta in your body, thereby elevating the levels of Brilinta in your bloodstream. Examples of antifungal drugs that may increase your risk of side effects when taken with Brilinta include:

• Posaconazole (Noxafil)
• Ketoconazole
• Voriconazole (Vfend)
• Itraconazole (Tolsura, Sporanox)

If you need to take an antifungal drug while on Brilinta, your doctor will closely monitor you for signs and symptoms of bleeding. Depending on your situation, your doctor may also recommend a reduced dosage of either Brilinta or the antifungal medication.

Certain Antiviral Drugs: Combining Brilinta with specific antiviral medications can elevate your risk of experiencing side effects, such as bleeding. This occurs because some antivirals inhibit the breakdown of Brilinta in your body, increasing Brilinta’s blood levels. Examples of antiviral drugs that may enhance your risk of side effects when taken with Brilinta include:

• Nefazodone
• Nelfinavir (Viracept)
• Ritonavir (Norvir)
• Saquinavir (Invirase)
• Atazanavir (Reyataz)

Many of these drugs are used in combination therapies. It is crucial to inform your doctor or pharmacist about all antiviral medications you are taking to avoid potential severe side effects.

If you are prescribed any of these antiviral drugs alongside Brilinta, your doctor will monitor you closely for signs of increased bleeding.

Certain Seizure Drugs: Taking Brilinta alongside specific medications used for treating seizures may decrease Brilinta’s effectiveness. This reduction in effectiveness occurs because certain seizure medications accelerate the breakdown of Brilinta in your body, lowering the levels of Brilinta in your blood. Examples of seizure drugs that can diminish the effectiveness of Brilinta if taken together include:

• Phenytoin (Phenytek, Dilantin)
• Carbamazepine (Equetro, Carbatrol, Tegretol)
• Phenobarbital

If you require seizure medication, your doctor might recommend an alternative to the drugs listed above. This strategy helps avoid interactions that can compromise Brilinta’s effectiveness.

Certain Cholesterol Drugs: Using Brilinta along with certain cholesterol medications, specifically simvastatin (Zocor) and lovastatin (Altoprev), can heighten your risk of experiencing serious side effects from these cholesterol drugs. This increased risk is because Brilinta inhibits the breakdown of simvastatin and lovastatin in your body, resulting in elevated levels of these drugs in your bloodstream. If you need to take simvastatin or lovastatin while you are on Brilinta, your doctor will carefully manage the dosage, ensuring it does not exceed 40 mg daily to minimize the risk of adverse effects.

Opioid Pain Relievers: Taking Brilinta alongside opioids, which are strong pain relievers, can interfere with the absorption of Brilinta from your stomach into your bloodstream. This interference can render Brilinta less effective. Examples of opioids that might reduce the effectiveness of Brilinta include:

• Hydrocodone (Hysingla ER)
• Morphine (MS Contin)
• Oxymorphone
• Hydromorphone (Dilaudid)
• Oxycodone (Xtampza ER, Roxicodone)
• Codeine
• Methadone (Methadose)
• Fentanyl (Fentora, Actiq)

If you need to take an opioid while on Brilinta, your doctor may suggest using an injectable form of the opioid instead of an oral form to avoid this absorption issue. Additionally, your doctor will advise using the opioid for the shortest duration necessary to manage your pain effectively.

Supplements and Herbs: Currently, there are no specific herbs or supplements known to interact with Brilinta. However, it’s important to consult your doctor or pharmacist before starting any new herbs or supplements while on Brilinta to ensure there are no potential interactions.

Grapefruit Interaction: Consuming grapefruit or grapefruit juice while taking Brilinta may increase your risk of experiencing side effects, such as bleeding. Grapefruit inhibits the breakdown of Brilinta in your body, which results in higher levels of the drug in your bloodstream. Discuss with your doctor whether it is safe for you to consume grapefruit or grapefruit juice while undergoing treatment with Brilinta.

[Note: This isn’t a complete list, and there could be other drugs that interact with Brilinta. Make sure to tell your doctor any prescription, over-the-counter medicines, and herbal products you’re taking.]

Brilinta Alternatives

• Aspirin
• Effient (prasugrel)
• Aspirin-dipyridamole ER
• Xarelto (rivaroxaban)
• Cilostazol
• Plavix (clopidogrel)
• Eliquis (apixaban)
• Lovenox (enoxaparin)
• Persantine (dipyridamole)
• Arixtra (fondaparinux)
• Aggrenox (dipyridamole/aspirin)
• Pradaxa (dabigatran)
• Jantoven (warfarin)
• Savaysa (edoxaban)
• Heparin
• Ticlopidine
• Eptifibatide

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

Frequently Asked Questions

When is the best time of day to take Brilinta?

You should take Brilinta at the same times each day, such as one tablet in the morning and another in the evening. Your doctor will typically also recommend taking a low-dose aspirin along with Brilinta. Aspirin is commonly used to help prevent blood clots.

Can you drink coffee while taking Brilinta?

There is no documented interaction between caffeine and Brilinta, and studies suggest that consuming caffeine is generally safe for individuals taking Brilinta. However, it’s important to consult your doctor or pharmacist for personalized advice regarding your caffeine intake while on Brilinta, including recommendations on safe amounts specific to your health condition.

Can you take Brilinta just once a day?

Brilinta is not prescribed as a once-daily medication. The standard dosing schedule for Brilinta involves taking it twice a day. In some cases, a one-time higher “loading dose” of Brilinta may be used at the start of treatment to quickly establish effective drug levels in your body. After the loading dose, you will continue with the regular twice-daily dosing.

Does shortness of breath go away with Brilinta?

Shortness of breath is a known side effect for 14% to 21% of individuals taking Brilinta, as observed in clinical trials. This side effect is usually mild and tends to improve over time as you continue taking the medication. Significantly, it does not damage the lungs. If you experience shortness of breath while taking Brilinta, discussing this with your doctor is crucial, especially if the symptom is persistent or bothersome.

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