Do not drink grapefruit juice while taking Brilinta (ticagrelor). Grapefruit juice can inhibit (block) one of the enzymes (3A4) needed to break down Brilinta for excretion from the body. Theoretically, drinking grapefruit juice with Brilinta may increase the antiplatelet effect of your medicine and increase the risk for bleeding. Ask your doctor about this possible drug-food interaction.

Brilinta (ticagrelor) is an oral antiplatelet prescription tablet that is usually taken twice a day, in the morning and the evening. It is used with a daily maintenance dose of aspirin. It is approved by the FDA for these uses:

• to reduce the risk of cardiovascular death, a heart attack or stroke in patients with acute coronary syndrome (ACS) or a history of a heart attack. For at least the first 12 months following ACS, it is superior to clopidogrel.
• to reduce the risk of a clot formation in stents of patients who have been stented for treatment of ACS.
• to reduce the risk of a first heart attack or stroke in patients with coronary artery disease (CAD) at high risk for such events.
• to reduce the risk of stroke in patients with acute ischemic stroke (NIH Stroke Scale score ≤5) or high-risk transient ischemic attack (TIA)

Grapefruit juice and Brilinta: Study

In one study, ten healthy volunteers ingested 200 ml of grapefruit juice or water three times a day for 4 days and a single 90 mg dose of ticagrelor on day three.

• The authors concluded that grapefruit juice markedly increased the plasma concentrations and antiplatelet effect of ticagrelor.
• This effect was most likely due to inhibition (blocking) of the CYP3A4-mediated first pass metabolism of ticagrelor mainly at the intestinal level.
• The researchers noted that the use of ticagrelor and grapefruit juice is best to be avoided while the patient is taking this drug.

In general, taking medications at a different time from when you drink grapefruit juice will not prevent the interaction. The effects of grapefruit juice on some medications can last for over 24 hours. Even if you take a medicine that is only given once per day, you should avoid grapefruit and grapefruit juice for the entire treatment period.

Brilinta and vitamin K: Can I eat spinach with Brilinta?

You do not need to worry about eating green leafy vegetables like spinach, broccoli, kale, or other vitamin K-rich foods with Brilinta. You can enjoy these healthy foods while you are taking Brilinta.

Brilinta, an antiplatelet, works differently from warfarin (brand name: Coumadin), an anticoagulant. Vitamin K is an essential part of our body's blood clotting process. Warfarin effects may be altered by changing levels of vitamin K in your body, but this is not a concern with Brilinta.

What other foods affect Brilinta absorption?

Your Brilinta (ticagrelor) dose can be taken with or without food. Food (other than grapefruit or grapefruit juice) will not affect how well your medication works or the maximum amount that is absorbed. However, be sure to take your medication at the same time each day, only as directed by your doctor.

Bottom Line

• You may need to avoid grapefruit juice while taking Brilinta. One study showed that grapefruit juice can more than double Brilinta (ticagrelor) exposure. This can lead to a greater effect on antiplatelet inhibition and theoretically could increase your risk for bleeding. Speak to your doctor about this possible interaction if you consume grapefruit juice regularly or on a daily basis.
• Green leafy vegetables can still be consumed safely with Brilinta as this drug does not affect the vitamin K clotting factors.
• Brilinta (ticagrelor) is manufactured by AstraZeneca and was first approved by the FDA in July 2011.