Brilinta (Ticagrelor)

Prescription Required.

Product of Canada.

Shipped from Canada.

Prescription Required.Product of Canada.Shipped from Canada.

Brilinta (Ticagrelor)

What is Brilinta (Ticagrelor)?

Brilinta (ticagrelor) is an antiplatelet agent or platelet aggregation inhibitor medication that is used alongside aspirin to prevent heart attacks, strokes, and death associated with cardiovascular disease. It is also used in patients who have recently received a stent and require improved blood flow to avoid clotting occur.

How is Brilinta Used?

Brilinta should be taken exactly as instructed by the patient’s doctor. Most commonly, this is a twice-daily dose of the medication. This medication may be taken with food, or patients may take it on an empty stomach. However, Brilinta should be swallowed down along with plenty of water.

Patients taking the 90 mg tablet of Brilinta that struggle to swallow the medication whole may crush the tablet into a fine powder and mix it well into a half-glass of water. Once mixed, this solution should be consumed immediately. Afterward, this individual should drink another half-glass of water to properly wash the medication down and ensure it is properly and fully consumed.

Most individuals using Brilinta will also be taking aspirin (acetylsalicylic acid) alongside the medication for treatment. Patients should not take more aspirin than instructed while using Brilinta as this may actually make Brilinta less effective.

Storage

Brilinta tablets should be stored at room temperature, as close as possible to 77°F (25°C). It is permissible to allow this medication to temporarily reach a low temperature of 59°F (15°C) or a high temperature of 86°F (30°C).

Keep this medication out of the reach of pets and children at all times.

Uses

Brilinta is prescribed for a variety of cardiovascular conditions, including but not limited to:

  • acute coronary syndrome
  • coronary artery disease
  • heart attack (myocardial infarction)
  • ischemic stroke
  • prevention of heart attack, stroke, and atherothrombotic events

How Does Brilinta Work?

Brilinta is an antiplatelet medication. These function by making the platelets within the bloodstream unable to stick together as much as they usually would, thereby preventing clotting and the development of blood clots from occurring. By preventing clotting from occurring, Brilinta is able to reduce the risk of blood clots that contribute to individuals experiencing strokes and heart attacks.

Dosage

Brilinta is available in tablet form in the following strengths:

  • 60 mg
  • 90 mg

In patients with ACS (acute coronary syndrome), the typical initial dose of Brilinta used for treatment is two 90 mg tablets (180 mg) of Brilinta for the very first dose, and then they will be required to take a twice-daily dose of 90 mg each following this starting dose.

When a patient has received any type of surgery to open up blocked or narrowed blood vessels (i.e., receiving a stent), has type 2 diabetes, and has coronary artery disease, they will often be prescribed a twice-daily dose of 60 mg.

Patients that have a history of heart attack more than 12 months prior and require the use of Brilinta to prevent clots will commonly take a twice-daily dose of 60 mg of Brilinta.

Regardless of the condition for which Brilinta has been prescribed and the commonly recommended dosages for such conditions, patients should be sure to take the medication exactly as prescribed by their own physician.

Overdose

If an overdose of Brilinta has occurred or is suspected, patients are advised to contact their doctor or local Poison Control Center. Some of the potential side effects of an overdose of Brilinta include diarrhea, vomiting, an irregular heartbeat, nausea, and severe bleeding.

Side Effects

The most common side effects of taking Brilinta are as follows:

  • bleeding
  • bruising

Some of the following side effects may occur and should be discussed with your doctor if they remain persistent or increase in severity while taking Brilinta:

  • constipation
  • coughing
  • diarrhea
  • difficulty sleeping
  • dizziness
  • headaches
  • heartburn
  • itchiness
  • nausea
  • pain in the abdomen
  • the sensation of spinning
  • tingling sensations
  • tiredness or fatigue
  • vomiting
  • weakness in the muscles

Patients that experience any of the following severe symptoms should stop using Brilinta and seek emergency medical attention immediately:

  • symptoms of brain bleeding
    • confusion
    • headache that is severe and comes on suddenly
    • loss of consciousness
    • nausea
    • vomiting
  • symptoms of an allergic reaction
    • difficulty breathing
    • hives
    • swelling of the throat, tongue, mouth, or face
  • symptoms of stomach bleeding
    • spitting up blood
    • stools that are black, bloody, or tarry
    • vomiting blood
    • vomiting what looks like coffee grounds
  • symptoms of stroke
    • changes in vision
    • dizziness that comes on suddenly
    • headache
    • numbness
    • trouble walking
    • weaknes

If you experience any of the following additional side effects, please contact your prescribing physician as soon as possible:

  • anemia symptoms
    • dizziness
    • paleness
    • shortness of breath
    • unusual weakness or fatigue
  • bleeding
    • blood in the eye
    • blood in urine
    • nosebleeds
    • tarry and black stools
  • anxiety
  • confusion
  • fainting
  • gout symptoms
    • warmth and swelling of the joints
    • joint pain
  • heart failure symptoms
    • coughing
    • swelling of the lower legs, ankles, or feet
    • shortness of breath
  • hypotension
    • blurred vision
    • dizziness
    • feeling lightheaded
  • irregular, slow, or fast heartbeat
  • kidney stones
    • pain in the back and side (below the individual’s ribs)
    • painful urination
  • lung fibrosis symptoms
    • aching muscles and joints
    • fatigue
    • dry cough
    • shortness of breath
    • unexplained reduction in weight
  • pain in the chest
  • rash on the skin
  • shortness of breath
  • stomach inflammation
  • swelling of the ankles or legs
  • symptoms of hypertension in the lungs
    • fatigue
    • dizziness
    • rapid pulse
    • shortness of breath
  • TTP (thrombotic thrombocytopenic purpura)
    • confusion
    • extreme tiredness
    • fever
    • jaundice (yellowing of the eyes or skin)
    • purple spots on the mouth or skin
  • unusual bruising

Warnings & Precautions

There are a variety of warnings and precautions associated with Brilinta. Please be sure to discuss your medical history and all current medications and conditions before beginning treatment with this medication.

Aspirin

Aspirin, or acetylsalicylic acid (ASA), is typically used alongside Brilinta for treatment. The amount of aspirin required for treatment may vary amongst individuals, and patients should be sure to follow their prescribing physician’s instructions regarding dosing and administration. However, the daily dose of aspirin ingested should not exceed a maximum of 150 mg.

Bleeding

Bleeding is the most common long-term side effect of using Brilinta, and individuals that are already at risk of bleeding before using Brilinta should discuss this with their physician before beginning treatment with this medication. Any patients that experience easy bruising, tarry and black stools, blood in their urine, or reduced ability to stop bleeding after a cut has occurred should report this to their doctor as soon as possible.

Breathing Issues

One of the possible side effects of using Brilinta is shortness of breath. Typically, most patients’ bodies adjust to Brilinta over time, and this side effect tends to improve. However, patients with chronic obstructive pulmonary disease or asthma should be sure to inform their physician of these conditions before beginning treatment with Brilinta, as they may impact the safety of using the medication. Breathing-related side effects are often mild or moderate in nature, but having preexisting conditions that affect the patient’s ability to breathe may be negatively impacted by the use of Brilinta.

Changes in Heart Rhythm

Brilinta is capable of causing changes in heart rhythm in some patients. Patients with any of the following factors should discuss these with their physician before beginning treatment with Brilinta: experiencing fainting as a result of a slow heart rate, 2nd-degree heart block, 3rd-degree heart block, sick sinus syndrome, any other abnormal heart rhythm-related conditions, or current use of any medications to slow down your heart rate (e.g., metoprolol, verapamil, diltiazem, atenolol). The presence of any of these conditions or the use of any of the mentioned medications may result in changes being made to the dosage of Brilinta to ensure that it is able to be used both safely and effectively.

Gout and High Uric Acid Levels

Brilinta is associated with an increased amount of uric acid building up within patients’ blood. Patients with a medical history of gout or high uric acid levels should be sure to inform their physician of such conditions before beginning treatment with Brilinta, as these may both impact the efficacy of the medication and may require monitoring during treatment. Any individuals using Brilinta that develop urination difficulties or have their joints become warm, swollen, or painful should report this to their prescribing physician as soon as possible.

Grapefruit Juice

Brilinta is affected by the consumption of grapefruit juice. Grapefruit juice causes Brilinta to not be properly removed from the patient’s body, and this can result in a build-up of too much Brilinta within the individual, further resulting in more numerous or more significant side effects. Patients using Brilinta should avoid drinking grapefruit juice or eating grapefruit while using this medication.

Kidney and Liver Function

Patients that are currently receiving dialysis may require special monitoring as dialysis may affect Brilinta, and Brilinta may impact the condition for which the patient is receiving dialysis. Impaired kidney function may also alter the efficacy and required dosage of Brilinta that is necessary for treatment.

As Brilinta is processed in the liver, impaired liver function or liver disease may result in excess amounts of Brilinta building up within the body and resulting in side effects that may be more noticeable or severe. If you currently have impaired liver function or have a history of liver disease, please discuss how this may affect your treatment with Brilinta. Individuals with reduced liver function that is moderate to severe should not be prescribed Brilinta.

Pregnancy and Breastfeeding

It has not been determined whether Brilinta is safe for use during pregnancy or if it is passed through breast milk. Patients using Brilinta are advised to avoid becoming pregnant while being treated with this medication. If a patient becomes pregnant while using Brilinta, they should inform their prescribing physician immediately. Additionally, due to the lack of studies regarding breastfeeding and the use of Brilinta, patients should discuss the potential risks of their medication passing through breast milk and affecting the baby receiving this milk.

Surgery

Due to the bleeding risks associated with Brilinta, patients with any type of upcoming surgical procedure will need to stop using this medication beforehand. Please speak to your prescribing physician regarding when and how to stop using Brilinta before your scheduled surgery.

When Stopping This Medication

Patients that stop using Brilinta will once again have an increased risk of experiencing a heart attack and stroke. Some individuals may need to stop using Brilinta to manage certain side effects, but this should only be done under the guidance of their physician, and they should return to using the medication once the adverse side effects have been resolved.

Drug Interactions

Speak to your doctor about any medications or herbal supplements you are currently taking before beginning treatment with Brilinta. Discuss any concerns you may have with your doctor or a trusted pharmacist.

Drugs That Are Known to Interact with Brilinta

The following medications are known to interact with Brilinta:

  • acetylsalicylic acid (ASA) when consumed in doses above 150 mg daily
  • anagrelide
  • apalutamide
  • apixaban
  • aprepitant
  • atazanavir
  • atorvastatin
  • -azole antifungals
  • bismuth subsalicylate
  • bosentan
  • carbamazepine
  • celecoxib
  • clarithromycin
  • clopidogrel
  • cobicistat
  • codeine
  • conivaptan
  • crizotinib
  • cyclosporine
  • dabigatran
  • dalteparin
  • dasatinib
  • deferasirox
  • desvenlafaxine
  • digoxin
  • diltiazem
  • dipyridamole
  • dong quai
  • dronedarone
  • duloxetine
  • edoxaban
  • efavirenz
  • elagolix
  • enoxaparin
  • enzalutamide
  • erythromycin
  • etravirine
  • evening primrose
  • fentanyl
  • feverfew
  • fluoxetine
  • fluvoxamine
  • garlic
  • ginger
  • glucosamine
  • grapefruit juice
  • heparin
  • herbal products that have an effect on bleeding
  • HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • HIV protease inhibitors
  • hydrocodone
  • ibuprofen
  • imatinib
  • itraconazole
  • ivacaftor
  • ketoconazole
  • ketoprofen
  • lovastatin
  • low molecular weight heparins (LMWHs)
  • lumacaftor
  • macrolide antibiotics
  • mifepristone
  • modafinil
  • morphine
  • multivitamins
  • naproxen
  • narcotics pain relievers
  • nelfinavir
  • nevirapine
  • nilotinib
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • obinutuzumab
  • omega-3 fatty acids
  • oxycodone
  • pentoxifylline
  • phenobarbital
  • phenytoin
  • prasugrel
  • primidone
  • protein kinase inhibitors
  • rifabutin
  • rifampin
  • ritonavir
  • rivaroxaban
  • saquinavir
  • sarilumab
  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • sertraline
  • simvastatin
  • siltuximab
  • -statin anti-cholesterol medications
  • John’s wort
  • telithromycin
  • ticlopidine
  • tocilizumab
  • tinzaparin
  • tranexamic acid
  • venlafaxine
  • verapamil
  • vilazodone
  • vitamin E
  • voriconazole
  • warfarin

Alternative Medications

For patients who are unable to take Brilinta or experiencing significant adverse side effects, alternative medications may be used to treat some of the associated conditions for which this medication is commonly prescribed:

  • amlodipine (Norvasc)
  • apixaban (Eliquis)
  • aspirin
  • clopidogrel (Plavix)
  • cilostazol
  • evolocumab (Repatha)
  • icosapent ethyl (Vascepa)
  • lisinopril (Prinivil, Qbrelis, Zestril)
  • metoprolol (Lopressor, Toprol XL)
  • nitroglycerin
  • prasugrel (Effient)
  • rivaroxaban (Xarelto)

Frequently Asked Questions

The most common side effects experienced by those using Brilinta are easier bleeding and bruising. Most patients using Brilinta also have nosebleeds more frequently. Additionally, serious side effects, such as shortness of breath or severe bleeding, are also possible when using this medication. Serious injuries, especially those involving internal bleeding, are a medical emergency for those taking Brilinta and may require surgery or transfusions to avoid fatal results.

Brilinta increases an individual’s risk of experiencing bleeding or bruising, meaning that it is much easier for patients using this medication to develop bruises or experience significant bleeding, it will take more time and be more difficult to make any bleeding stop, and there is also an increased likelihood of experiencing nosebleeds. However, there are precautions one using this medication may take to lower the risk of injury and prevent certain bleeding events.

While using Brilinta, patients are at an increased risk of experiencing bleeding as well as bruising. Some of the things you can do to assist you in avoiding causing bruising or bleeding include the following: getting plenty of rest, exercising additional care in avoiding bumping against things, using a humidifier to keep the nasal packages moist to avoid nosebleeds, practicing good exercise and dietary habits to avoid constipation, avoid blowing your nose intensely, using a soft toothbrush to prevent damage and bleeding to your gums, using an electric razor, and using an emery board rather than nail clippers when trimming your nails.

Brilinta should not be used by any individual that is allergic to its main ingredient (ticagrelor) or any of the other ingredients contained within the medication, that currently has bleeding, or that has a history of experiencing brain bleeding.

Brilinta is a medication that is intended to decrease the stroke risk in individuals having mini-strokes or transient ischemic attacks, decrease the risk of stroke or a first heart attack in those who have coronary artery disease or other high-risk factors for experiencing a stroke or heart attack, and decrease the risk of stroke, heart attack, and death in those who have a history of experiencing heart attacks or that have acute coronary syndrome that results in blood flow blockages within the body. Brilinta may also be used in those with acute coronary syndrome who have received stents, and it assists in reducing the potential for blood clots to form within the stent.

Patients should follow all dosing and administration instructions from their prescribing physician when taking Brilinta. Individuals using this treatment combination should not exceed a daily dose of 100 mg of aspirin, as this will impact the efficacy of Brilinta. Patients currently taking any medications that also contain aspirin should inform their doctor of this, and they should not begin using any aspirin-related medications that are new when being treated with Brilinta.

Most commonly, patients using Brilinta will take one tablet in the morning and another in the evening while incorporating a once-daily dose of 81 mg of aspirin. Individuals who experienced a heart attack longer than one year ago should take a once-daily dose of 81 mg of aspirin along with a twice-daily dose of 60 mg of Brilinta. If a patient is using Brilinta after being hospitalized for severe chest pain or a heart attack within the past years or more recently, they should take a once-daily dose of 81 mg of aspirin along with taking 90 mg of Brilinta twice daily. Patients should take Brilinta only as instructed by their prescribing physician.

Before taking Brilinta, patients should be sure to inform their physician about any of the following potential aspects that may be included in their medical history: a history of lung-related issues (i.e., asthma or COPD), any previous problems associated with bleeding, previous history of colon polyps or stomach ulcers, liver conditions, or any recent surgeries or injuries. Patients should also notify their doctor if they are pregnant, planning to become pregnant, breastfeeding, planning to breastfeed, or have any upcoming dental procedures or other surgeries.

Before beginning treatment with Brilinta, it is essential that patients notify their prescribing physician if they are taking any of the following additional medications: Rifampin, anti-seizure medications, blood thinners, medicines to treat high cholesterol, oral antifungal medications, HIV-AIDS medications, or any medications for hypertension or other heart conditions.

In a one-year study involving over 18,000 patients, Brilinta with aspirin was shown to be more effective at preventing stroke, heart attack, and death associated with a cardiovascular event by comparison to Plavix and aspirin.

In a study spanning four years and involving 21,000 patients, taking Brilinta along with aspirin was proven to be more effective at preventing stroke, heart attack, and death associated with a cardiovascular event.

Brilinta is used for the following: ischemic stroke, acute coronary syndrome, coronary artery disease, and the prevention of ischemic stroke, heart attack, thromboembolic stroke, and atherothrombotic events.

Patients using Brilinta should not breastfeed while taking this medication. If you are pregnant or planning to become pregnant, please consult with your physician, as the effects of Brilinta on an unborn child have not yet been established.

The active ingredient in Brilinta is ticagrelor. The following inactive ingredients are also included in Brilinta tablets: titanium dioxide, sodium starch glycolate, polyethylene glycol 400, mannitol, magnesium stearate, Hypromellose, hydroxypropyl cellulose, ferric oxide, dibasic calcium phosphate. The 90 mg tablets also contain talc and ferric oxide yellow.

Patients taking Brilinta should limit or avoid alcohol consumption due to the increased risk of stomach bleeding associated with aspirin. Additionally, individuals using this medication with aspirin should avoid taking medications that contain similar ingredients to aspirin, as these will increase their bleeding risk. Examples of such medications include cold/flu medicines and medications commonly used for swelling, fever, or pain (e.g., naproxen, ketoprofen, ibuprofen, and salicylates).

If a patient has missed a dose of Brilinta, they should not take two doses at once to compensate for the missed dose. They should simply take their next scheduled dose at the usual time.

If an overdose of Brilinta had occurred or is suspected, the individual’s local Poison Control center or their physician should be contacted as soon as possible for further advice and information. If Brilinta has been ingested and results in an individual collapsing or being unable to breathe, emergency medical attention should be sought immediately.

Brilinta is available in tablet form in strengths of 60 mg and 90 mg.