7 Brilinta (Ticagrelor) Interactions to Consider

Brilinta (ticagrelor) belongs to a class of blood thinners known as antiplatelet medications. It’s often prescribed to prevent heart attacks and strokes caused by unwanted blood clots. While Brilinta can be a lifesaving medication, it has some drug interactions to be aware of while you’re taking it. 

Let’s review seven key Brilinta interactions and how to manage them. Keep in mind, this list doesn’t include all medications that interact with Brilinta. 

 1. Other prescription blood thinners

As mentioned, Brilinta is a type of blood thinner and antiplatelet medication. If it’s combined with other medications that also thin your blood, it can raise your risk of easy or heavy bleeding.

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Examples of blood thinners that can interact with Brilinta include:

• Warfarin (Coumadin, Jantoven)

• Apixaban (Eliquis)

• Rivaroxaban (Xarelto)

• Dabigatran (Pradaxa) 

• Clopidogrel (Plavix)

Good to know: You may need to combine Brilinta with another prescription blood thinner for certain health conditions. But this should only happen with guidance from a healthcare provider. 

2. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) can also raise your risk of bleeding. They include common over-the-counter (OTC) pain medications, such as ibuprofen (Advil) and naproxen (Aleve). NSAIDs are also available as prescription medications. The risk for bleeding goes up if you combine NSAIDs with Brilinta.

If you need a pain or fever medication while taking Brilinta, acetaminophen (Tylenol) is likely your safest option. Avoid taking NSAIDs unless your provider OKs it. The one exception to this is low-dose aspirin — more on that next.

High doses of aspirin

Brilinta is often taken along with low-dose (81 mg) aspirin. This combination is fine as long as your healthcare provider recommends it. But you shouldn’t take low-dose aspirin with Brilinta on your own. The risk of bleeding may outweigh the possible benefit of low-dose aspirin for some people.

You also should avoid higher doses of aspirin (over 100 mg) while you’re taking Brilinta. Higher aspirin doses can make Brilinta less effective. This can raise your risk of unwanted blood clots. There’s a boxed warning (the FDA’s most serious warning) about this interaction on Brilinta’s official labeling.

3. Certain anti-seizure medications

Some medications that treat seizures can lower the amount of Brilinta in your body. This can make it less effective at preventing blood clots.

Examples include: 

• Carbamazepine (Tegretol)

• Phenytoin (Dilantin)

• Phenobarbital 

• Primidone (Mysoline)

It’s best to avoid combining these medications with Brilinta. So be sure to let your provider know if you’re taking one of them. A different blood thinner medication may be a better fit for you.

4. Opioids

Opioids are often prescribed for moderate to severe pain. Examples include hydrocodone / acetaminophen (Lorcet, Norco) and oxycodone (Oxycontin, Roxicodone). 

Opioids can lower Brilinta levels if they’re taken together. If you’re taking opioids for pain control, a different blood thinner may be a better option for you.

5. Certain statins

Statins are commonly prescribed to help lower cholesterol levels. Brilinta can raise the levels of certain statins in your body if they’re combined. This could raise your risk of statin side effects, such as muscle pain.

Simvastatin (Zocor, FloLipid) and lovastatin (Altoprev) are the most likely to interact with Brilinta. You shouldn’t take more than 40 mg of these statins per day while you’re taking Brilinta. For other statins, such as atorvastatin (Lipitor) and rosuvastatin (Crestor), you don’t need a dose adjustment if you take them with Brilinta. 

If you’re taking a statin, let your provider know. They can help decide if you’ll need a dosage change while you’re taking Brilinta.

6. Digoxin

Brilinta can raise digoxin (Lanoxin) levels in the body if they’re taken together. Digoxin treats certain heart conditions, and it’s a drug with a narrow therapeutic index. This means that small changes in digoxin levels can lead to new or worsening side effects.

You’ll likely have your digoxin levels checked regularly while you’re taking it. But you may need them tested more often if you start taking Brilinta. This will help your provider make sure your digoxin levels don’t go too high.

Signs and symptoms of high digoxin levels include: 

• Nausea and vomiting 

• Diarrhea

• Yellow- or green-tinted vision

• Abnormal heartbeat

If you notice any of these signs or symptoms while you’re taking digoxin and Brilinta, seek medical care right away.

7. Anti-infection medications

Some medications can raise Brilinta levels in the body. This can lead to a higher risk of bleeding or other Brilinta side effects.

Medications that can raise Brilinta levels include several that treat fungal, viral, or bacterial infections. Examples include:

• Nirmatrelvir / ritonavir (Paxlovid)

• Atazanavir (Reyataz)

• Ketoconazole

• Itraconazole (Sporanox)

• Clarithromycin (Biaxin XL)

• Erythromycin (Ery-Tab, E.E.S.)

If you’re taking one of these medications long term, a different blood thinner may be a better option for you. But if you’re taking one of them for a short time, your provider may decide it’s OK to keep taking Brilinta or pause it for a short time. In this case, be sure to follow your provider’s instructions closely.

Good to know: Grapefruit also can raise Brilinta levels in a similar way as the above medications. So it’s best to avoid grapefruit and grapefruit juice while you’re taking Brilinta. 

When should I contact my healthcare provider about a Brilinta interaction?

It’s best to review your current medication list with your healthcare provider and pharmacist before you start taking Brilinta. They can screen for any interactions that may be an issue. You’ll often begin taking Brilinta in a hospital setting. So don’t forget to mention medications and supplements that you’re taking at home. You should also let them know if you start or stop any medications or supplements while taking Brilinta.

It’s also a good idea to let your healthcare provider know if you notice any signs of bleeding while taking Brilinta. These can include bleeding gums, minor bruising, or nosebleeds.

More serious bleeding needs medical attention right away. Symptoms include:

• Bleeding that doesn’t stop

• Large bruises that don’t heal

• Blood in your urine

• Blood in your stool (it may be bright red or black)

• Coughing or vomiting blood

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Written by:

Justin DeFlorian, PharmD, BCPS

Justin DeFlorian, PharmD, BCPS, is a board-certified clinical pharmacist. He received his Doctor of Pharmacy degree from the University of Wisconsin-Madison.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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