Ticagrelor: Dosage, Side Effects & Antiplatelet Medication Guide

Summary or Key Points

Ticagrelor is a prescription antiplatelet medication used to reduce the risk of heart attack, stroke, and other cardiovascular events in adults with certain heart or blood vessel conditions. It works by preventing blood clots from forming in the arteries. Ticagrelor is commonly prescribed for conditions such as acute coronary syndrome and atherosclerosis. Always consult your healthcare provider before starting or adjusting your dose.

Names of Medication

US Brand Name: Brilinta

Generic Name: Ticagrelor

The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. The generic name is listed in parentheses.

Pharmacologic Category

Antiplatelet Agent

P2Y12 Platelet Inhibitor

Ticagrelor Dosage

Ticagrelor is prescribed to manage various cardiovascular conditions in adults. The Ticagrelor dosage depends on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dosage. If you need to speak with a healthcare provider, you can schedule a telemedicine appointment with one of our doctors today.

Common Dosages for Specific Conditions

1. Acute Coronary Syndrome (ACS): Typically, 180 mg is taken as two 90 mg tablets initially, followed by 90 mg twice daily. Treatment usually lasts at least 12 months.
2. Myocardial Infarction (Heart Attack): The standard dose is 90 mg twice daily for at least 12 months.
3. Unstable Angina: The recommended dose is 180 mg initially, followed by 90 mg twice daily. Treatment typically lasts 12 months.
4. Coronary Artery Disease (CAD): For patients with CAD but no history of stroke or heart attack, the dose is 60 mg twice daily.
5. Stroke: Ticagrelor is prescribed at 90 mg twice daily for patients who have had a stroke, typically for 12 months.
6. Peripheral Artery Disease (PAD): The usual dose is 60 mg twice daily.
7. Atherosclerosis: The dose is 60 mg twice daily for long-term prevention of cardiovascular events.
8. Thrombosis (Blood Clots): The typical dose is 90 mg twice daily for at least 12 months.
9. Ischemic Heart Disease: The standard dose is 90 mg twice daily for at least 12 months.

Dosage Forms and Strengths

Tablet, Oral: 60 mg, 90 mg

Administration Instructions for Ticagrelor

Ticagrelor should be taken orally, with or without food. It’s important to take this medication at the same time each day to maintain consistent levels in your bloodstream. Do not crush or chew the tablets. If you miss a dose, take it as soon as you remember, but if it’s close to your next dose, skip the missed dose. Never double up on doses. Always follow your healthcare provider’s instructions carefully.

Ticagrelor Side Effects and Adverse Reactions

Like all medications, Ticagrelor can cause side effects. Not everyone will experience them, but it’s important to be aware of potential reactions. If you experience any severe side effects, contact your healthcare provider immediately.

Common Ticagrelor Side Effects

1. Shortness of breath
2. Headache
3. Dizziness
4. Nausea

These side effects are generally mild and may resolve on their own.

Less Common Side Effects

1. Bleeding, including nosebleeds, bruising, or prolonged bleeding from cuts

If you notice unusual bleeding, contact your healthcare provider.

Serious Side Effects

1. Severe bleeding
2. Allergic reactions, such as rash, itching, swelling, or trouble breathing

Seek emergency medical help if you experience these symptoms.

Contraindications for Ticagrelor

A contraindication is a specific situation or condition where a medication should not be used because it may be harmful. Before starting Ticagrelor, it’s important to know if you have any conditions that make it unsafe for you to take this medication.

Contraindications for Ticagrelor

1. Active bleeding: Ticagrelor increases the risk of bleeding. If you have any active bleeding, such as a stomach ulcer or bleeding in the brain, taking Ticagrelor could worsen the condition.
2. History of intracranial hemorrhage: If you’ve had bleeding in your brain before, Ticagrelor could increase the risk of recurrence.
3. Severe liver disease: Ticagrelor is processed by the liver. If your liver is not functioning properly, the medication may not be broken down correctly, leading to higher levels in your body and an increased risk of side effects.
4. Allergy to Ticagrelor: If you are allergic to Ticagrelor or any of its ingredients, you should not take this medication as it could cause a severe allergic reaction.

If you have any of these conditions, discuss them with your healthcare provider before starting Ticagrelor. You can schedule a telemedicine appointment with one of our providers to review your medical history and determine the best treatment for you.

Drug to Drug Interactions with Ticagrelor

Some medications can interact with Ticagrelor, affecting how it works or increasing the risk of side effects. Be sure to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements.

Medications that Interact with Ticagrelor Include:

1. Strong CYP3A inhibitors: These drugs can increase Ticagrelor levels in your blood, raising the risk of side effects. Examples include:
1. Ketoconazole (Nizoral)
2. Clarithromycin (Biaxin)
3. Ritonavir (Norvir)
4. Strong CYP3A inducers: These drugs can reduce Ticagrelor’s effectiveness by lowering its levels in your blood. Examples include:
1. Rifampin (Rifadin)
2. Phenytoin (Dilantin)
3. Carbamazepine (Tegretol)
4. Other blood thinners: Taking Ticagrelor with other blood thinners can increase your risk of bleeding. Examples include:
1. Warfarin (Coumadin)
2. Apixaban (Eliquis)
3. Rivaroxaban (Xarelto)
4. Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), can increase the risk of bleeding when taken with Ticagrelor.

If you are taking any of these medications, talk to your healthcare provider about potential alternatives or adjustments. You can consult one of our telemedicine providers to review your medication list and ensure there are no harmful interactions.

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Ticagrelor in Pregnancy

Is it safe to take Ticagrelor when pregnant?

There is limited information on the safety of Ticagrelor during pregnancy. While animal studies suggest some potential risks, there are no well-controlled studies in pregnant women. Since Ticagrelor increases the risk of bleeding, it may pose additional concerns during pregnancy, particularly during labor and delivery. If you are pregnant or planning to become pregnant, it’s important to discuss the potential risks and benefits of Ticagrelor with your healthcare provider. You can also schedule a telemedicine appointment with one of our providers to explore your treatment options.

Ticagrelor while Breastfeeding

Is it safe to take Ticagrelor while breastfeeding?

It is not clear whether Ticagrelor passes into breast milk. Due to the potential for serious side effects in a nursing infant, it is generally recommended to avoid breastfeeding while taking Ticagrelor. If you are breastfeeding or planning to breastfeed, consult your healthcare provider to discuss alternative treatments or whether you should discontinue breastfeeding while on this medication.

Estimated Cost of Ticagrelor Medication

The cost of a 30-day supply of Ticagrelor (Brilinta) without insurance can vary. With a GoodRX coupon, the estimated cost is around $400 to $450 for a 30-day supply of 90 mg tablets. Prices may differ depending on the pharmacy and location. Be sure to check for available discounts or patient assistance programs if cost is a concern.

Possible Alternatives to Ticagrelor

Depending on your condition, alternative treatments or lifestyle changes may help manage your symptoms. It’s essential to discuss these options with your healthcare provider before making any changes to your treatment plan. You can also consult one of our telemedicine providers to explore alternatives that may better suit your needs.

For Acute Coronary Syndrome (ACS):

1. Alternative medications: Clopidogrel (Plavix), Prasugrel (Effient)
2. Lifestyle changes: Quitting smoking, adopting a heart-healthy diet, regular exercise

For Myocardial Infarction (Heart Attack):

1. Alternative medications: Aspirin, Beta-blockers, ACE inhibitors
2. Lifestyle changes: Managing stress, maintaining a healthy weight, cardiac rehabilitation

For Unstable Angina:

1. Alternative medications: Nitroglycerin, Calcium channel blockers
2. Lifestyle changes: Reducing alcohol intake, controlling blood pressure, regular physical activity

For Coronary Artery Disease (CAD):

1. Alternative medications: Statins, ACE inhibitors
2. Lifestyle changes: Lowering cholesterol, managing diabetes, increasing physical activity

For Stroke Prevention:

1. Alternative medications: Aspirin, Warfarin (Coumadin), Apixaban (Eliquis)
2. Lifestyle changes: Controlling high blood pressure, avoiding excessive alcohol, quitting smoking

For Peripheral Artery Disease (PAD):

1. Alternative medications: Cilostazol (Pletal), Pentoxifylline (Trental)
2. Lifestyle changes: Walking programs, smoking cessation, managing cholesterol

For Atherosclerosis:

1. Alternative medications: Statins, Fibrates
2. Lifestyle changes: Eating a diet low in saturated fats, increasing fiber intake, regular exercise

For Thrombosis:

1. Alternative medications: Heparin, Warfarin (Coumadin)
2. Lifestyle changes: Staying active, avoiding prolonged immobility, maintaining a healthy weight

For Ischemic Heart Disease:

1. Alternative medications: Beta-blockers, Calcium channel blockers
2. Lifestyle changes: Reducing stress, following a heart-healthy diet, regular physical activity

For Heart Attack Prevention:

1. Alternative medications: Aspirin, Statins
2. Lifestyle changes: Managing cholesterol, controlling blood pressure, quitting smoking

Recent Updates on Ticagrelor Research

Recent studies have explored the use of Ticagrelor in combination with other medications to improve outcomes in patients with coronary artery disease and stroke. A 2021 study found that combining Ticagrelor with aspirin in certain high-risk patients reduced the risk of major cardiovascular events compared to aspirin alone. However, the combination also increased the risk of bleeding, making it essential to carefully weigh the benefits and risks with your healthcare provider.

Ongoing research is also investigating Ticagrelor’s potential use in patients with peripheral artery disease and its role in reducing the risk of limb complications. These studies are still in progress, and more data is needed to fully understand the benefits and risks of Ticagrelor in these populations.

If you have questions about the latest research or how it may apply to your treatment, our telemedicine providers are available to discuss your options and help you make informed decisions about your care.

James Kingsley

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