Brilinta (ticagrelor)

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, 2^nd-degree heart block, 3^rd-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: