Brilinta
Brilinta (ticagrelor) is an antiplatelet blood thinner used to lower the risk of heart-related death, heart attack, or stroke in people with certain heart conditions. It comes as a tablet that's taken by mouth twice per day. It's a brand-name medication only, so a generic version isn't available. Side effects include shortness of breath, bleeding, and nausea.
What is Brilinta (ticagrelor)?
What is Brilinta (ticagrelor) used for?
Lowering the risk of heart-related death, heart attack, and stroke in people with acute coronary syndrome (ACS) or who've had a previous heart attack
Lowering the risk of a first-time heart attack or stroke in high-risk people with coronary artery disease (CAD)
Lowering the risk of stroke in people who've had a previous stroke or a high-risk transient ischemic attack (TIA) (also called "mini stroke")
How Brilinta (ticagrelor) works
Brilinta (ticagrelor) is a type of antiplatelet medication called a P2Y12 inhibitor. It works by preventing blood cells called platelets from clumping together and forming blood clots in your heart or brain. This lowers your risk for a heart attack or stroke.
Drug Facts
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What are the side effects of Brilinta (ticagrelor)?
Common Side Effects
- Shortness of breath (14%)
- Bleeding (12%)
- Dizziness (5%)
- Nausea (4%)
Other Side Effects
- Diarrhea
- Slow heart rate
- Sleep apnea
- Skin rash
Serious Side Effects
- Severe bleeding: bleeding that doesn't stop, blood in the urine, vomiting or coughing up blood, bloody or dark-colored stools, severe stomach pain or discomfort
Source: DailyMed
More on Brilinta (ticagrelor) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Back pain
bleeding gums
blurred vision
chest pain, tightness, or discomfort
confusion
coughing up blood
difficult or trouble breathing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fast, slow, or irregular heartbeat
headache
increased menstrual flow or vaginal bleeding
lightheadedness, dizziness, or fainting
loss of consciousness
nausea or vomiting
nervousness
nosebleeds
paralysis
pounding in the ears
prolonged bleeding from cuts
red or black, tarry stools
red or dark brown urine
sweating
unusual bleeding or bruising
unusual tiredness or weakness
Rare
Change in mental status
difficulty in speaking
pale skin
pinpoint red spots on the skin
seizures
yellow eyes or skin
Incidence not known
Difficulty with swallowing
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
rash
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Brilinta (ticagrelor)
Pros
Good choice for lowering the risk of heart-related death, heart attack, or stroke in people with certain heart-related problems
Can be taken with other blood thinners, if necessary
Can be taken with or without food
Tablets can be crushed and mixed with water for people who have trouble swallowing
Cons
Must be taken twice a day
Might have to be taken with a daily aspirin
Can cause serious bleeding
Not safe for people with severe liver problems
Pharmacist tips for Brilinta (ticagrelor)
You can take Brilinta (ticagrelor) with or without food. But nausea is a common side effect, so taking it with food can help ease this side effect.
It's best to avoid grapefruit and grapefruit juice while taking Brilinta (ticagrelor) because they can cause your body to absorb more medication, which raises your risk for side effects.
If you can't swallow the Brilinta (ticagrelor) tablet whole, you can split or crush it. Mix the crushed tablet with water and drink it all at once. Then, refill the cup with water, stir, and drink again to make sure you get the full dose.
Take Brilinta (ticagrelor) twice a day at the same time every day. If you miss your dose, take your next dose at the next regularly scheduled time. Don't take 2 doses at the same time to make up for the missed dose.
Brilinta (ticagrelor) can make you bruise or bleed more easily. Get medical help right away if you feel lightheaded, dizzy, are vomiting or coughing up blood, or have blood in your stool. These are signs of bleeding that might be happening inside your body.
Get medical help if you fall and hit your head while taking Brilinta (ticagrelor). Although the risk is low, you should be urgently seen to make sure you don't have any brain bleeds.
Brilinta (ticagrelor) interacts with many medications, such as ibuprofen (Advil), opioid pain medications, and certain statins. Tell your care team about all of the medications and supplements that you're taking or planning on taking with Brilinta (ticagrelor). They can make sure your medications are as safe for you as possible.
Brilinta (ticagrelor) can be taken with low-dose aspirin (75 mg to 100 mg) once per day. It's generally not recommended to take more than 100 mg of aspirin with Brilinta (ticagrelor)if you have a history of heart attack because this can reduce how well Brilinta (ticagrelor) works. Only take Brilinta (ticagrelor) with aspirin if your prescriber recommends it, as combining them raises your risk of bleeding.
Speak to a nutritionist to come up with a heart-healthy diet and exercise plan to follow while you're taking Brilinta (ticagrelor). This can help further lower your risk for another heart attack.
Never stop taking Brilinta (ticagrelor) unless a healthcare professional (HCP) specifically instructs you to do so. Stopping the medication too early can raise your risk of blood clots forming in your body, which can potentially lead to serious and life-threatening issues. If you would like to stop Brilinta (ticagrelor) or switch to another blood thinner, ask your HCP how to do so safely.
Frequently asked questions about Brilinta (ticagrelor)
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What are the risks and warnings for Brilinta (ticagrelor)?
Brilinta (ticagrelor) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Bleeding
Risk factors: Taking other medications that raise the risk for bleeding (e.g., antiplatelets, anticoagulants, NSAIDs, corticosteroids)| Bleeding problems | Liver problems | Recent or upcoming surgery
Brilinta (ticagrelor) is a blood thinner, so it raises your risk for bleeding. It can also make it take longer than usual for bleeding to stop. You might also notice that you get bruises more easily or have more bleeding when you get a cut or nosebleed.
Make sure to tell your prescriber if you're taking other medications that can cause bleeding. Additionally, tell them if you're scheduled for any surgery or procedure because you might need to stop taking Brilinta (ticagrelor) 5 or more days before.
Tell your prescriber right away if you notice any abnormal bleeding, see any blood in your stool or urine, cough up blood, or feel dizzy. Get medical help right away if you have a fall, head injury, or other kinds of physical injury since you might have bleeding inside your body. And contact your prescriber right away if you have dark or tarry stool or bleeds that are hard to stop.
Risk of heart attack if stopped suddenly or too early
Risk factors: Stopping Brilinta (ticagrelor) suddenly or too early | Recent heart attack or stent placement
Don't stop taking Brilinta (ticagrelor) unless your prescriber specifically tells you it's safe to do so. Stopping the medication too early can raise your risk of getting blood clots. This in turn can raise your risk for heart attack or stroke. Contact your prescriber so they can create a safe plan for you if you want to stop Brilinta (ticagrelor).
Shortness of breath
Brilinta (ticagrelor) can cause mild to moderate shortness of breath, but it usually goes away after taking the medication for a while. If you become short of breath and it's too bothersome for you, contact your prescriber, but continue taking Brilinta (ticagrelor) as directed.
Slow heart rate
Risk factors: History of irregular heart rhythms | Conditions that cause very slow heart rate
Brilinta (ticagrelor) can cause a very slow heart rate (less than 60 beats per minute) and pauses in heartbeats. Be sure to discuss all your medical conditions with your healthcare team, especially if you have heart rhythm problems, before starting this medication.
Sleep apnea
Brilinta (ticagrelor) has been linked to sleep apnea, a condition where breathing stops for short periods of time during sleep. If you experience symptoms like daytime sleepiness, difficulty concentrating, or headaches, let your prescriber know.
Brilinta (ticagrelor) dosage forms
Typical dosing for Brilinta (ticagrelor)
Lowering the risk of heart-related death, heart attack, and stroke in people with ACS or who've had a previous heart attack: The typical dose is a single dose of 180 mg by mouth on day 1, then 90 mg by mouth two times a day for the first year. After the first year, the dose is 60 mg by mouth two times a day.
Lowering the risk of a first-time heart attack or stroke in high-risk people with CAD: The typical dose is 60 mg by mouth two times a day.
Lowering the risk of stroke in people who've had a previous stroke or a high-risk TIA: The typical dose is a single dose of 180 mg by mouth on day 1, then 90 mg by mouth two times a day for up to 30 days.
More on Brilinta (ticagrelor) dosage forms
Interactions between Brilinta (ticagrelor) and other drugs
More on Brilinta (ticagrelor) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Defibrotide
- Itraconazole
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Abciximab
- Aceclofenac
- Acemetacin
- Alipogene Tiparvovec
- Amiodarone
- Amtolmetin Guacil
- Anagrelide
- Apalutamide
- Apixaban
- Argatroban
- Aspirin
- Atazanavir
- Betrixaban
- Bivalirudin
- Bromfenac
- Bufexamac
- Caplacizumab-yhdp
- Carbamazepine
- Celecoxib
- Ceritinib
- Choline Salicylate
- Cilostazol
- Citalopram
- Clarithromycin
- Clonixin
- Clopidogrel
- Cobicistat
- Dabigatran Etexilate
- Danaparoid
- Desirudin
- Desvenlafaxine
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyridamole
- Dipyrone
- Domperidone
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Droxicam
- Duvelisib
- Edoxaban
- Eliglustat
- Enzalutamide
- Eptifibatide
- Escitalopram
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Fluconazole
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Fosnetupitant
- Fosphenytoin
- Heparin
- Ibrutinib
- Ibuprofen
- Idelalisib
- Ifosfamide
- Indinavir
- Indomethacin
- Inotersen
- Ivosidenib
- Ketoconazole
- Ketoprofen
- Ketorolac
- Larotrectinib
- Lefamulin
- Lepirudin
- Levomilnacipran
- Lorlatinib
- Lornoxicam
- Loxoprofen
- Lumacaftor
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Mitotane
- Morniflumate
- Morphine
- Morphine Sulfate Liposome
- Nabumetone
- Naloxegol
- Naproxen
- Nefazodone
- Nelfinavir
- Nepafenac
- Netupitant
- Niflumic Acid
- Nilotinib
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Olaparib
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Paroxetine
- Phenindione
- Phenobarbital
- Phenprocoumon
- Phenylbutazone
- Phenytoin
- Piketoprofen
- Piperaquine
- Piracetam
- Piroxicam
- Pixantrone
- Prasugrel
- Proglumetacin
- Propyphenazone
- Proquazone
- Protein C
- Rifampin
- Ritonavir
- Rivaroxaban
- Rofecoxib
- Salicylic Acid
- Salsalate
- Saquinavir
- Selumetinib
- Sertraline
- Simeprevir
- Sodium Salicylate
- St John's Wort
- Sulfinpyrazone
- Sulindac
- Telithromycin
- Tenoxicam
- Tiaprofenic Acid
- Ticlopidine
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Trazodone
- Treprostinil
- Valdecoxib
- Vilazodone
- Vorapaxar
- Voriconazole
- Vortioxetine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Brilinta (ticagrelor) cost?
Brilinta (ticagrelor) contraindications
History of brain bleed
Active bleeding
What are alternatives to Brilinta (ticagrelor)?
Lowering the risk of heart-related death, heart attack, and stroke in people with acute coronary syndrome (ACS) or who've had a previous heart attack
Lowering the risk of a first-time heart attack or stroke in high-risk people with coronary artery disease (CAD)
Lowering the risk of stroke in people who've had a previous stroke or a high-risk transient ischemic attack (TIA) (also called "mini stroke")
Heart attack prevention
Stroke prevention
Prevention of blood clot problems in people who received a stent after a heart attack
What is the latest news about Brilinta (ticagrelor)?
Brilinta (ticagrelor) images
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References
Best studies we foundAmerican Heart Association. (2024). Acute coronary syndrome.
AstraZeneca Pharmaceuticals LP. (2024). Brilinta- ticagrelor tablet [package insert]. DailyMed.
Bálint, A., et al. (2021). Network meta-analysis of ticagrelor for stroke prevention in patients at high risk for cardiovascular or cerebrovascular events. Stroke.
Damman, P., et al. (2012). P2Y12 platelet inhibition in clinical practice. Journal of Thrombosis and Thrombolysis.
Easton, J. D., et al. (2017). Risk for major bleeding in patients receiving ticagrelor compared with aspirin after transient ischemic attack or acute ischemic stroke in the SOCRATES study (acute stroke or transient ischemic attack treated with aspirin or ticagrelor and patient outcomes). Circulation.
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.
Krakowiak, A., et al. (2020). Ticagrelor-related severe dyspnoea: Mechanisms, characteristic features, differential diagnosis and treatment. Clinical Medicine Insights: Case Reports.
National Cancer Institute. (n.d.). Platelet.
Navarese, E. P., et al. (2020). Comparative efficacy and safety of oral P2Y12 inhibitors in acute coronary syndrome: Network meta-analysis of 52 816 patients from 12 randomized trials. Circulation.
Rajappan, K. (2018). 119 Bradyarrhythmias. Diagnosis and Treatment in Internal Medicine.
Wallentin, L., et al. (2009). Ticagrelor versus clopidogrel in patients with acute coronary syndromes. The New England Journal of Medicine.
Wei, P., et al. (2024). Progress in the clinical effects and adverse reactions of ticagrelor. Thrombosis Journal.
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