Ticagrelor

Key facts

• Ticagrelor (brand name Brilinta or Brilique) is an antiplatelet medicine. It stops platelets, tiny blood cells, from clumping together to start a clot.
• You take it twice daily, usually alongside a low dose of aspirin, for a period your cardiologist sets after a heart attack or stent.
• Never stop ticagrelor early without your cardiologist's advice, especially after a stent. Stopping too soon can let a clot form inside the stent, which can cause a sudden heart attack.
• Seek urgent care for black or bloody stools, blood in vomit or urine, a sudden severe headache, or breathlessness that is new or getting worse.

What ticagrelor treats

Ticagrelor lowers the risk of a further heart attack, stroke or cardiovascular death in people with acute coronary syndrome, a term covering heart attacks and severe unstable chest pain. It is also used after coronary stent placement, combined with aspirin for a period your cardiologist sets, and in some people with a history of heart attack who remain at high risk.

How ticagrelor works

Ticagrelor blocks a receptor on platelets (P2Y12) that normally drives them to clump together and recruit more platelets into a growing clot. Unlike clopidogrel, it binds reversibly, so its antiplatelet effect wears off faster once you stop, usually within a few days rather than a week.

Before you take it

• Tell your prescriber about any bleeding disorder, stomach ulcer, history of bleeding in the brain, or severe liver disease.
• Do not take ticagrelor with aspirin doses above 100mg a day. High-dose aspirin reduces how well ticagrelor works and raises bleeding risk; your combined regimen should use low-dose aspirin only.
• Ticagrelor commonly causes breathlessness (dyspnoea), often in the first week and usually mild. Tell your prescriber if it is severe, sudden, or does not settle, since it needs to be told apart from a heart or lung problem.
• It interacts with strong CYP3A medicines, including some antifungal and HIV drugs, which can raise its levels substantially; avoid large amounts of grapefruit juice.

Side effects

Common effects include breathlessness, bruising, and mild dizziness.

Stop and seek urgent medical care for any of these:

• Black or tarry stools, blood in urine or vomit, or bleeding that will not stop.
• Sudden or severe breathlessness, chest pain, or fainting.
• A sudden severe headache or vision changes.

Safety essentials

• Do not stop ticagrelor early, particularly in the months after a stent, without talking to your cardiologist first. Stopping too soon is a leading cause of clotting inside the stent, which can be fatal.
• Keep any aspirin dose at 100mg a day or below; higher doses work against ticagrelor and add bleeding risk without added benefit.
• Tell every clinician and dentist you take ticagrelor before any procedure, and report new or worsening breathlessness rather than assuming it is unrelated to the medicine.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.