Key takeaways:
Brilinta (ticagrelor) is an antiplatelet medication used to prevent strokes and other dangerous blood clots. Taking Brilinta with other blood thinners and nonsteroidal anti-inflammatory drugs (NSAIDs) can raise your risk of bleeding.
Other Brilinta interactions include some anti-seizure medications, opioids, and certain statins. You should also use caution when taking Brilinta with digoxin, some anti-infectives, and alcohol.
You should tell your prescriber and pharmacist about all the supplements and medications you take. They can check to make sure they’re safe to take with Brilinta.
Save on related medications
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. Knowing about them in advance can help protect your safety while taking Brilinta.
Brilinta interactions at a glance
Below is a list of possible Brilinta interactions. Keep in mind, this list doesn’t include all medications and substances that interact with Brilinta. It’s best to review your current medication list with your healthcare team before you start taking it. 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 your healthcare team know if you start or stop any medications or supplements while taking Brilinta.
Possible Brilinta interactions include:
Other blood thinners
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Some anti-seizure medications
Opioids
Some statins
Digoxin
Some antifungal medications
Some antibiotics
Some antiviral medications
Alcohol
Grapefruit juice
It’s also a good idea to let your healthcare team know if you notice any signs of bleeding while taking Brilinta. These can include bleeding gums, minor bruising, or nosebleeds and may be signs of an interaction.
More serious bleeding needs emergency medical attention. Possible symptoms include:
Bleeding that doesn’t stop
Large bruises that don’t heal
Blood in your urine
Coughing or vomiting blood
Let’s take a closer look at eight Brilinta interactions you should be aware of.
1. Other prescription blood thinners
As mentioned, Brilinta is a type of blood thinner. If it’s combined with other medications that also thin your blood, it can raise your risk of bleeding.
Examples of blood thinners that can interact with Brilinta include:
Warfarin (Coumadin, Jantoven)
Eliquis (apixaban)
Xarelto (rivaroxaban)
Pradaxa (dabigatran)
Plavix (clopidogrel)
How does Brilinta work? Read pharmacist answers to this and more commonly asked questions about Brilinta (ticagrelor).
Brilinta dosages: Learn about the different recommended dosages of Brilinta based on what you’re taking it for.
Antiplatelets vs. anticoagulants: Here’s what to know about the differences between these two types of blood thinner medications.
In most cases, you’ll only take one blood thinner at a time to lower your bleeding risk. You may need to combine Brilinta with another prescription blood thinner for certain health conditions. But this should only happen if your prescriber recommends it.
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 Advil (ibuprofen) and Aleve (naproxen). NSAIDs are also available as prescription medications.
The risk for bleeding goes up if you combine NSAIDs with Brilinta. So if you need a pain or fever medication while taking Brilinta, Tylenol (acetaminophen) is likely your safest option. Avoid taking NSAIDs unless your prescriber OKs it. The one exception to this is low-dose aspirin — more on that next.
High doses of aspirin
You’ll often take Brilinta along with a low-dose (81 mg) aspirin. This combination is fine as long as your prescriber recommends it. But you shouldn’t take low-dose aspirin with Brilinta on your own. The risk of bleeding may outweigh the possible benefit 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.
3. Certain anti-seizure medications
Some anti-seizure medications can lower the amount of Brilinta in your body. This can make it less effective at preventing blood clots.
Examples include:
Tegretol (carbamazepine)
Dilantin (phenytoin)
Phenobarbital
Mysoline (primidone)
It’s best to avoid combining these medications with Brilinta. If you’re taking one of them, a different blood thinner medication may be a better fit for you. If you’re starting a new anti-seizure medication while taking Brilinta, your prescriber can recommend a safer option.
4. Opioids
Opioids are often prescribed for moderate to severe pain. Examples include hydrocodone / acetaminophen and oxycodone (OxyContin, Roxicodone).
Opioids can make Brilinta less effective 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 high 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.
Zocor (simvastatin) and Altoprev (lovastatin) 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. Other statins, such as Lipitor (atorvastatin) and rosuvastatin (Crestor), don’t require a dose adjustment if you take them with Brilinta. But there may still be an increased risk of side effects with this combination.
If you’re taking a statin, let your prescriber know before starting Brilinta. They can help decide if you’ll need a different dose or cholesterol medication.
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 medication 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 prescriber make sure your digoxin levels don’t go too high.
Signs and symptoms of high digoxin levels can 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 that treat fungal, viral, or bacterial infections can raise Brilinta levels in the body. This can lead to a higher risk of bleeding or other Brilinta side effects. Examples include:
Paxlovid (nirmatrelvir / ritonavir)
Reyataz (atazanavir)
Oral ketoconazole
Sporanox (itraconazole)
Biaxin XL (clarithromycin)
Ery-Tab (erythromycin)
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 prescriber may decide it’s OK to keep taking Brilinta or pause it for a short time. In this case, be sure to follow your prescriber’s instructions closely.
Good to know: Grapefruit can raise Brilinta levels the same way as the above medications. So it’s best to avoid large amounts of grapefruit and grapefruit juice while you’re taking Brilinta.
8. Alcohol
Alcohol doesn’t interact with Brilinta directly. But it can thin your blood and raise your risk of serious bleeding events. And this risk can go up if you combine alcohol and Brilinta. So it’s best to avoid alcohol or keep your intake to a minimum while taking Brilinta.
If you have questions or concerns about drinking alcohol while taking Brilinta, talk to your healthcare team. They can provide guidance based on your personal history.
Frequently asked questions
In most cases, you’ll need to take Brilinta for 6 to 12 months after a stent is placed. But in some cases, it may be a lifelong medication. Your prescriber will let you know how long you need to take Brilinta based on your personal history. Don’t stop taking Brilinta on your own, as this can raise your risk of blood clots.
You can take Brilinta with or without food. But if taking it on an empty stomach causes nausea, taking it with food may help. Unlike with warfarin, you don’t have to follow a specific diet while taking Brilinta. But choosing heart-healthy foods is a good idea for your overall health. Taking Brilinta with your morning and evening meals can also help you remember to take it on a regular basis.
In most cases, you’ll take Brilinta twice a day. It’s best to separate your doses by 8 to 12 hours. Taking Brilinta doses too close together or too far apart could raise the risk of side effects or leave you unprotected against blood clots. So try to choose times that help you take it consistently, such as around breakfast and dinner times.
In most cases, you’ll need to take Brilinta for 6 to 12 months after a stent is placed. But in some cases, it may be a lifelong medication. Your prescriber will let you know how long you need to take Brilinta based on your personal history. Don’t stop taking Brilinta on your own, as this can raise your risk of blood clots.
You can take Brilinta with or without food. But if taking it on an empty stomach causes nausea, taking it with food may help. Unlike with warfarin, you don’t have to follow a specific diet while taking Brilinta. But choosing heart-healthy foods is a good idea for your overall health. Taking Brilinta with your morning and evening meals can also help you remember to take it on a regular basis.
In most cases, you’ll take Brilinta twice a day. It’s best to separate your doses by 8 to 12 hours. Taking Brilinta doses too close together or too far apart could raise the risk of side effects or leave you unprotected against blood clots. So try to choose times that help you take it consistently, such as around breakfast and dinner times.
The bottom line
Combining Brilinta (ticagrelor) with other blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) can raise your risk of bleeding. Opioids and certain anti-seizure medications can lower Brilinta levels and make it less effective.
Other medications that interact with Brilinta include digoxin, certain statins, and some medications that treat viral, bacterial, or fungal infections. You should also avoid or limit alcohol while taking Brilinta. Be sure to let your prescriber and pharmacist know about all supplements and medications you take. They can check to see if they’re safe to combine with Brilinta.
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References
Amneal Pharmaceuticals NY. (2025). Ticagrelor- ticagrelor tablet [package insert].
Barnes, G. D. (2020). Combining antiplatelet and anticoagulant therapy in cardiovascular disease. Hematology.
Fernando, H., et al. (2021). Effects of lignocaine vs. opioids on antiplatelet activity of ticagrelor: The LOCAL trial. European Heart Journal.
Holmberg, M. T., et al. (2013). Grapefruit juice markedly increases the plasma concentrations and antiplatelet effects of ticagrelor in healthy subjects. British Journal of Clinical Pharmacology.
MedlinePLus. (2023). Digitalis toxicity.
Rocca, B., et al. (2024). Ticagrelor and statins: Dangerous liaisons? Cardiovascular Drugs and Therapy.
