Brilinta vs. Plavix to Prevent Blood Clots: 7 Factors to Consider

When it comes to managing heart conditions, antiplatelet medications play an important role. Brilinta (ticagrelor) and Plavix (clopidogrel) are two common medications in this class. Both help prevent unwanted blood clots. But there are differences between them to consider.

Below, we’ll compare Brilinta and Plavix. This should help you get a better understanding of whether one might be a better option for you.

1. Brilinta and Plavix work in a similar way to prevent blood clots, but there’s one key difference

While they have differences, Brilinta and Plavix work in a similar way. Both are considered antiplatelet medications. Platelets are blood cells involved in the formation of blood clots. Both Brilinta and Plavix work by preventing platelets from clumping together to form blood clots. This helps prevent heart attacks and strokes caused by blood clots.

The main difference between how Brilinta and Plavix work is that Plavix is a prodrug. This means it has to be activated by an enzyme (protein) in your liver before it can start working. And some people, particularly those of East Asian descent, make less of this enzyme than others. If there isn’t enough enzyme to activate Plavix, it can’t work properly to prevent blood clots.

Brilinta isn’t a prodrug and doesn’t need to be activated in order to work. So it’s a better choice if you have a low level of the liver enzyme needed to activate Plavix. Your healthcare provider can help determine if this applies to you.  

2. Brilinta is approved for more uses than Plavix

Both Brilinta and Plavix are FDA-approved to prevent a heart attack or stroke if you’ve already had one.

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But Brilinta is also approved to prevent a heart attack or stroke from happening, even if you’ve never had one before. Your healthcare provider may prescribe it if you have coronary artery disease (CAD). CAD puts you at a high risk for heart attack or stroke.   

3. Brilinta is considered stronger and faster-acting than Plavix, but comes with a higher risk of bleeding

Brilinta and Plavix are both effective at preventing blood clots. But Brilinta is known for its strong and rapid antiplatelet effects. In studies, it started working faster than Plavix and had a greater blood thinning effect, too.

These effects are a good thing when it comes to preventing blood clots. But they’re not great when it comes to bleeding risk. Brilinta has a higher risk of bleeding-related side effects while you’re taking it than Plavix. 

Your healthcare provider will look at your full medical history to decide which medication is best for you. 

Good to know: One exception to the higher bleeding risk with Brilinta is when it comes to surgical procedures. It’s best to stop taking an antiplatelet medication at least 5 days before surgery. This lowers the chance of excess bleeding during your procedure. Brilinta seems to stop working faster than Plavix for some people after you stop taking it. So it may cause less bleeding during surgery than Plavix for some people.

4. Brilinta is dosed twice a day, while Plavix is dosed once a day

Brilinta dosages range from 60 mg to 90 mg by mouth twice daily. You can take Brilinta with or without food. And it can be crushed and mixed with water if you have trouble swallowing pills.

Plavix is only taken once a day, at a dose of 75 mg. You can also take it with or without food. But it’s not recommended to crush Plavix — it should be swallowed whole.

Good to know: When you first start taking Brilinta or Plavix, you’ll often begin with a one-time dose that’s larger than your normal daily dose. This is known as a loading dose. It helps Brilinta and Plavix start working faster to prevent blood clots. After the loading dose, a lower daily dose is prescribed for ongoing use.

The recommended loading dose for Brilinta is a one-time dose of 180 mg. The loading dose of Plavix is a one-time dose of 300 mg or 600 mg.

5. In some cases, you’ll take low-dose aspirin along with Brilinta or Plavix

Combining Brilinta or Plavix with low-dose aspirin (75 mg to 100 mg) is common to reduce the risk of blood clots. This is known as dual antiplatelet therapy (DAPT). DAPT is often prescribed after a heart attack or stroke to prevent another one from happening.

Aspirin works differently to block platelets. So when it’s combined with Brilinta or Plavix, the antiplatelet effects are stronger. And there’s less of a chance for dangerous blood clots to form. 

Most people will take low-dose aspirin along with Brilinta. But it’s not always recommended with Plavix. Your healthcare provider will help you decide if DAPT is the best option for you.

Good to know: It’s best not to take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) while you’re taking Plavix or Brilinta unless your provider tells you to. The combination can increase your risk of bleeding. If you’re in need of an over-the-counter (OTC) pain or fever medication, talk to your healthcare provider or pharmacist about safer options for your symptoms.

6. Brilinta and Plavix have different drug interactions to be aware of

Brilinta and Plavix can interact with other medications or supplements you take. But they each have different drug interactions to consider. This may make one a better option for you, depending on the other medications you’re taking.

Brilinta interactions

Some medications raise Brilinta levels in the body if they’re taken together. This can make side effects such as shortness of breath or bleeding more likely. Examples include:

• Antifungals such as Sporanox (itraconazole) and ketoconazole

• Paxlovid (nirmatrelvir/ritonavir)

• Certain HIV medications, such as Norvir (ritonavir), Crixivan (indinavir), and Reyataz (atazanavir)

• Biaxin (clarithromycin)

Other medications lower Brilinta levels, making it less effective. These include: 

• Rifadin (rifampin)

• Dilantin (phenytoin)

• Tegretol (carbamazepine)

• Luminal (phenobarbital)

• Opioid pain medications

Brilinta can also raise the levels of other medications if you take them together. This can also raise your risk of side effects. Some examples include: 

• Lanoxin (digoxin) 

• Zocor (simvastatin)

• Altoprev (lovastatin)

Plavix interactions 

Plavix has different drug interactions than Brilinta. In some cases, a medication that lowers Brilinta levels can have the opposite effect when you take it with Plavix. 

Certain medications can lower Plavix levels and make it less effective. You should talk to your provider before taking Plavix with: 

• Proton pump inhibitors such as Prilosec (omeprazole) and Nexium (esomeprazole)

• Antifungal medications such as Diflucan (fluconazole) and ketoconazole 

• Prozac (fluoxetine)

• Opioid pain medications

• Grapefruit juice

Some medications can raise Plavix levels if they’re combined. Examples include: 

• Rifadin (rifampin)

• Dilantin (phenytoin)

Plavix can raise the levels of repaglinide, a medication for Type 2 diabetes, if they’re combined. This could raise your risk of low blood sugar, which can be dangerous. It’s not recommended to take these medications together.

7. There are ways to save on the cost of Brilinta and Plavix

There are many ways to save on Brilinta and Plavix. Both are available as brand-name medications. But you can also find Plavix as a lower-cost generic. GoodRx can help you navigate many ways to save on your prescription.

• Save with GoodRx. GoodRx can help you save over 90% off the average retail price of the generic version of Plavix. Generic clopidogrel’s price at certain pharmacies is as low as $4.50 with a free GoodRx discount.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Brilinta’s patient assistance program, which offers the medication free of cost.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Brilinta’s price is as little as $5 using a savings card from the manufacturer.

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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:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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