Drug Detail:Ticagrelor (Ticagrelor [ tye-ka-grel-or ])
Drug Class: Platelet aggregation inhibitors
Usual Adult Dose for Acute Coronary Syndrome
Following an acute coronary syndrome (ACS) event:
Loading dose: 180 mg orally once
Maintenance dose: 90 mg orally twice a day for 1 year
Maintenance dose after 1 year: 60 mg orally twice a day
Comments:
- This drug should be taken in conjunction with a daily maintenance dose of aspirin 75 to 100 mg orally once a day.
- For at least the first 12 months following ACS, this drug is superior to clopidogrel.
Uses:
- To reduce the rate of cardiovascular death, myocardial infarction, and stroke in patients with acute coronary syndrome (ACS) or a history of myocardial infarction.
- To reduce the rate of stent thrombosis in patients who have been stented for treatment of ACS.
Usual Adult Dose for Prevention of Atherothrombotic Events
Following an acute coronary syndrome (ACS) event:
Loading dose: 180 mg orally once
Maintenance dose: 90 mg orally twice a day for 1 year
Maintenance dose after 1 year: 60 mg orally twice a day
Comments:
- This drug should be taken in conjunction with a daily maintenance dose of aspirin 75 to 100 mg orally once a day.
- For at least the first 12 months following ACS, this drug is superior to clopidogrel.
Uses:
- To reduce the rate of cardiovascular death, myocardial infarction, and stroke in patients with acute coronary syndrome (ACS) or a history of myocardial infarction.
- To reduce the rate of stent thrombosis in patients who have been stented for treatment of ACS.
Usual Adult Dose for Thromboembolic Stroke Prophylaxis
60 mg orally twice a day
Comments: This drug should be used in conjunction with a daily maintenance dose of aspirin of 75 to 100 mg.
Use: To reduce the risk of a first myocardial infarction (MI) or stroke in patients with coronary artery disease (CAD) at high risk for such events; while use is not limited to this setting, efficacy of this drug was established in a population with type 2 diabetes mellitus (T2DM).
Usual Adult Dose for Coronary Artery Disease
60 mg orally twice a day
Comments: This drug should be used in conjunction with a daily maintenance dose of aspirin of 75 to 100 mg.
Use: To reduce the risk of a first myocardial infarction (MI) or stroke in patients with coronary artery disease (CAD) at high risk for such events; while use is not limited to this setting, efficacy of this drug was established in a population with type 2 diabetes mellitus (T2DM).
Usual Adult Dose for Myocardial Infarction - Prophylaxis
60 mg orally twice a day
Comments: This drug should be used in conjunction with a daily maintenance dose of aspirin of 75 to 100 mg.
Use: To reduce the risk of a first myocardial infarction (MI) or stroke in patients with coronary artery disease (CAD) at high risk for such events; while use is not limited to this setting, efficacy of this drug was established in a population with type 2 diabetes mellitus (T2DM).
Usual Adult Dose for Ischemic Stroke
Loading dose: 180 mg orally once
Maintenance dose: 90 mg orally twice a day for up to 30 days
Comments: This drug should be taken in conjunction with a loading dose of aspirin (300 to 325 mg) and a daily maintenance dose of aspirin 75 to 100 mg.
Use: To reduce the risk of stroke in patients with acute ischemic stroke (National Institutes of Health [NIH] Stroke Scale score 5 or less) or high-risk transient ischemic attack (TIA).
Usual Adult Dose for Ischemic Stroke - Prophylaxis
Loading dose: 180 mg orally once
Maintenance dose: 90 mg orally twice a day for up to 30 days
Comments: This drug should be taken in conjunction with a loading dose of aspirin (300 to 325 mg) and a daily maintenance dose of aspirin 75 to 100 mg.
Use: To reduce the risk of stroke in patients with acute ischemic stroke (National Institutes of Health [NIH] Stroke Scale score 5 or less) or high-risk transient ischemic attack (TIA).
Renal Dose Adjustments
No adjustment recommended
Liver Dose Adjustments
Mild liver dysfunction: No adjustment recommended
Moderate liver dysfunction: Limited clinical evidence; consider risks versus benefits of treatment
Severe liver dysfunction: Avoid use
Dose Adjustments
- Switching to ticagrelor from clopidogrel: Give the first ticagrelor 90 mg oral dose 24 hours after the last dose of clopidogrel
- Switching from prasugrel to ticagrelor has not been studied.
Precautions
CONTRAINDICATIONS:
- Hypersensitivity to this drug or any of its components
- Active pathological bleeding
- History of intracranial hemorrhage
US BOXED WARNINGS: BLEEDING RISK and ASPIRIN DOSE AND TICAGRELOR EFFECTIVENESS
- Bleeding risk: This drug, like other antiplatelet agents, can cause significant and sometimes fatal bleeding. Do not use this drug in patients with active pathological bleeding or a history of intracranial hemorrhage. Do not start in patients undergoing urgent coronary artery bypass graft surgery (CABG). If possible, manage bleeding without discontinuing this drug; stopping it increases the risk of subsequent cardiovascular events.
- Aspirin Dose and Ticagrelor Effectiveness: Maintenance doses of aspirin above 100 mg reduce the effectiveness of this drug and should be avoided.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- Administer with or without food
For patients who are unable to swallow tablets whole:
- The oral tablet can be crushed, mixed with water, and swallowed immediately; refill the glass with water, stir, and drink again.
- May administer via nasogastric tube (CH8 or greater).
Missed dose: If a dose is missed, take 1 dose at next scheduled time
General:
- This drug should be administered concurrently with aspirin unless specifically contraindicated.
- This drug is superior to clopidogrel for at least the first 12 months following acute coronary syndrome.
- Do not administer with another oral P2Y12 platelet inhibitor.
Monitoring:
- Hematologic: Signs and symptoms of bleeding
Patient advice:
- Instruct the patient that this drug will cause them to bleed and bruise more easily and to report any unexpected, excessive, or prolonged bleeding, blood in the stool/urine, or coughing up blood.
- Instruct patient to contact their health care professional if they experience shortness of breath, especially if severe.
- Instruct patients to check with health care professional when choosing over the counter products as this drug should not be taken with any other products that contain aspirin.
- Instruct patient to inform all physicians and dentists that they are taking this drug.
Frequently asked questions
- How long do I have to take Brilinta after a stent or heart attack?
- Brilinta vs Plavix: what's the difference?
- What pain medication can I take with Brilinta?
- Is ticagrelor better than clopidogrel?
- Is there a generic for Brilinta?
- Is Brilinta a blood thinner or antiplatelet?
- How long should Brilinta be held/stopped before surgery?
- Is ticagrelor a prodrug?
- What is Brilinta (ticagrelor) used for?
