What Is Brilinta?

Brilinta (ticagrelor) is an oral prescription drug used to prevent serious or life-threatening heart attack, stroke, or death in people who have had a heart attack or have a condition called acute coronary syndrome (ACS).

Brilinta can also help:

• Prevent blood clots in people who have a stent to treat ACS
• Lower the risk of a first heart attack or stroke in people with heart disease
• Lower the risk of a more serious stroke in people who are having a transient ischemic attack (ministroke) or a mild to moderate stroke

Brilinta is in a drug class called antiplatelet medications. It works by preventing blood cells called platelets from making clots that could cause a heart attack or stroke.

What Is Brilinta Used For?

The Food and Drug Administration (FDA) approved Brilinta to:

• Lower the risk of cardiovascular (heart) death, heart attack (myocardial infarction, or MI), or stroke, in people with ACS (a sudden blockage of blood flow to the heart) or who have had a heart attack
• Lower the risk of clotting in people who have had a stent to treat ACS
• Lower the risk of a first heart attack or stroke in people with heart disease who are at high risk (such as people with type 2 diabetes)
• Lower the risk of a more severe stroke in people with a transient ischemic attack (ministroke) or a stroke that is considered mild to moderate (five or less on the NIH Stroke Scale).

Brilinta is usually taken with a 75 milligram (mg) to 100 milligrams daily dose of aspirin (not to exceed 100 milligrams of aspirin per day).

How to Take Brilinta

Once you receive your Brilinta prescription, read the prescription label and the information leaflet that comes with it. Consult your healthcare provider if you have any questions. Use Brilinta exactly as directed, and do not skip doses. Your healthcare provider will tell you how much Brilinta to take and when to take it.

When taking Brilinta, remember to:

• Take your dose at about the same time each day.
• Take with or without food, but avoid drinking alcohol while using Brilinta and aspirin.
• Take Brilinta with aspirin at the dose recommended by your healthcare provider. Do not take more aspirin than recommended. Too much aspirin can make Brilinta less effective.
• Tell your healthcare providers that you take Brilinta. You may need to stop taking Brilinta for a few days before a surgery or a medical or dental procedure.

If you have trouble swallowing the tablet, you can crush the tablet. Mix with water, and drink all of the water immediately. Fill the glass with water again, stir, and drink all of it.

Brilinta makes you more likely to bleed. Contact your healthcare provider right away or get emergency medical help if you have bleeding that won't stop. Do not stop taking Brilinta unless your healthcare provider tells you to stop. Stopping Brilinta can increase your chance of having a heart attack or stroke.

Storage

Store at room temperature, away from heat, direct light, and moisture. Keep this medication out of reach and out of sight of children and pets. Keep the bottle tightly closed when not in use.

What Are the Side Effects of Brilinta?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The most common side effects of Brilinta are:

• Bleeding
• Shortness of breath
• Dizziness
• Nausea and diarrhea
• Increased levels of creatinine (a measure of kidney function)
  

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Severe bleeding: Call your healthcare provider right away if you have nosebleeds, bleeding that does not stop, unusual bleeding, easy bruising, black/blood/tarry stools, red or pink urine, coughing up blood, or if you have vomit that looks like coffee grounds.
• Hypersensitivity reaction or anaphylaxis: Symptoms can include rash, hives, swelling around the lips, tongue, and face, difficulty breathing, and require emergency medical attention. 
• Fainting: Notify your healthcare provider if you feel lightheaded, dizzy, feel like you will faint, or faint.
• AV block/bradyarrhythmia (the heart beats slowly or skips beats; symptoms include tiredness, dizziness, fainting, and shortness of breath)
• Thrombotic thrombocytopenic purpura (TTP, a rare and life-threatening blood disorder): Symptoms include red or purple spots under the skin, tiredness, fever, shortness of breath, stomach problems like nausea, vomiting, and diarrhea. Some people may experience confusion, seizures, coma, or a stroke.
• Sleep apnea: Tell your healthcare provider if you have irregular breathing when sleeping or if someone tells you that you are snoring or gasping for air while sleeping.

Long-Term Side Effects

While many people tolerate Brilinta well, long-term or delayed side effects are possible. Some long-term side effects can be mild, such as:

• Cough
• Back pain
• Swollen breast tissue in men

Moderate long-term side effects can include: 

• Increased levels of uric acid in the blood

Severe long-term side effects may include: 

• TTP
• Sleep apnea
• Intracranial bleeding (bleeding inside the skull)

Dosage: How Much Brilinta Should I Take?

Modifications

Brilinta is an oral medication that comes in tablet form. Some people have trouble swallowing pills and may need to modify how they take them. If you have difficulty swallowing Brilinta, you can crush the tablet. Mix with water, and drink all of the water immediately. Fill the glass with water again, stir, and drink all of it.

Impaired liver function can increase the risk for bleeding and other side effects because the liver processes the medication. For this reason, people with severe liver problems should not use Brilinta. However, people with mild liver problems can take Brilinta with caution. Discuss the risks vs benefits with your healthcare provider. Generally, it is OK for people with kidney problems to take Brilinta, but consult your healthcare provider for more information.

People who are pregnant or planning to become pregnant should consult their healthcare provider. You should not breastfeed while taking Brilinta because the drug is expected to be present in milk.

Missed Dose

If you miss a dose of Brilinta, skip the missed dose and take the next dose at the regular time. Do not take two doses together at the same time.

Overdose: What Happens If I Take Too Much Brilinta?

Taking too much Brilinta can cause bleeding, stomach problems (e.g., nausea, vomiting, diarrhea), or heart rate problems.

Precautions

What Are Reasons I Shouldn't Take Brilinta?

Brilinta is not appropriate for everyone. You should not take this medication if you are allergic to ticagrelor or any of the inactive ingredients in Brilinta. 

You also should not take Brilinta:

• If you have active bleeding
• If you have a history of intracranial hemorrhage
• Prior to undergoing urgent CABG surgery
• If you have severe liver problems
• Post fibrinolytic therapy: Brilinta may not be appropriate for people who have undergone recent fibrinolytic therapy as their reperfusion therapy as the recommended treatment is Plavix (clopidogrel).

This medication may also not be appropriate for people who underwent a recent and urgent CABG. In this case, your healthcare provider will weigh the risks versus benefits and may monitor Brilinta's use.

Brilinta may be prescribed with caution in some people only if the healthcare provider determines it is safe. This includes:

• People with moderate liver problems
• Older adults (65 years and older)
• People at risk of bleeding
• People undergoing an elective surgery within five days
• People without a pacemaker who have sick sinus syndrome (a condition where the heart's normal pacemaker cannot generate a normal heartbeat) or second or third-degree AV block

What Other Medications May Interact With Brilinta?

Tell your healthcare provider about all of your medicines, including prescription and over-the-counter (OTC) medicines and vitamins or supplements. The following drugs may interact with Brilinta.

Strong CYP3A Inhibitors

Brilinta interacts with drugs known as strong CYP3A inhibitors. These drugs interfere with how the body processes Brilinta, resulting in higher Brilinta levels. This can increase the risk of side effects like bleeding and shortness of breath. Examples of these drugs include:

• Biaxin (clarithromycin)
• Erythromycin
• Nizoral (ketoconazole)
• Norvir (ritonavir) and other drugs that contain ritonavir

Strong CYP3A Inducers

Brilinta also interacts with drugs known as strong CYP3A inducers. These drugs have the opposite effect. They decrease Brilinta levels, making Brilinta less effective. Examples of these drugs include:

• Dilantin (phenytoin)
• Phenobarbital
• Rifampin
• Tegretol (carbamazepine)

Aspirin

Although aspirin is taken along with Brilinta, aspirin doses of 100 milligrams or more per day can decrease the effectiveness of Brilinta and should be avoided. If you take any other OTC medicines for pain or cold and cough, make sure they do not contain aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Ask your pharmacist if you need help with the ingredients.

Alcohol

Avoid drinking alcohol if you take Brilinta with aspirin. Alcohol taken with aspirin can increase the risk of stomach bleeding.

Opioid Pain Medications

Opioid pain medications can decrease the effectiveness of Brilinta. Examples of opioids include:

• Oxycontin (oxycodone)
• Percocet (oxycodone and acetaminophen)
• Vicodin (hydrocodone and acetaminophen)

Certain Cholesterol Medications

Zocor (simvastatin) and Mevacor (lovastatin) interact with Brilinta. Brilinta increases levels of these cholesterol medications, which will require a dosage adjustment of the cholesterol medicine.

Lanoxin (Digoxin)

People who take digoxin will require close monitoring of digoxin levels while taking Brilinta.

Other drug interactions may occur with Brilinta. Consult your healthcare provider for a complete list of drug interactions.

What Medications Are Similar?

Brilinta is a blood thinner. There are two types of blood thinners: antiplatelets and anticoagulants. Brilinta is an antiplatelet drug.

Other antiplatelet medications include:

• Aggrastat (tirofiban) injection
• Aspirin
• Effient (prasugrel)
• Integrilin (eptifibatide) injection
• Persantine (dipyridamole)
• Plavix (clopidogrel)
• Pletal (cilostazol)
• Zontivity (vorapaxar)

Anticoagulants include:

• Arixtra (fondaparinux) injection
• Coumadin (warfarin)
• Eliquis (apixaban)
• Fragmin (dalteparin) injection
• Heparin injection
• Lovenox (enoxaparin)
• Pradaxa (dabigatran)
• Savaysa (edoxaban)
• Xarelto (rivaroxaban)
  

How Can I Stay Healthy While Taking Brilinta?

Before taking Brilinta, discuss your medical history and all medications you take with your healthcare provider. 

When taking Brilinta, follow your healthcare provider’s instructions for use. Read the patient information leaflet that comes with your prescription and ask your healthcare provider if you have any questions.

When you take a blood thinner, you are more prone to bleeding, and bleeding can take longer to stop. Here are some tips to help you stay as safe as possible:

• When shaving, use an electric razor to avoid cuts and scrapes.
• Use extra caution when using sharp objects like knives and scissors.
• File your nails with an emery board instead of using a nail clipper.
• Use a soft-bristle toothbrush to avoid bleeding gums. Avoid toothpicks.
• Use a vaporizer or humidifier to keep the air moist, especially in the winter. This can help avoid nosebleeds.
• Blow your nose gently.
• Avoid activities where you can get injured. Ask your healthcare provider what kind of exercise would be appropriate for you.
• Always wear a helmet if you ride a bike.
• Wear a medical alert so emergency responders know you take a blood thinner.
• Get emergency medical care if you fall or hit your head. Even if you are not visibly bleeding, you may have bleeding under the skin or in the skull. 
• When inside the house, wear shoes or non-slip slippers.
• Always wear shoes outside of the house.
• If you work outside, for example, gardening, wear appropriate gloves for using sharp tools or for working in the yard.