Ticagrelor (Brilinta): A Practical Patient Guide

Ticagrelor is a fast-acting antiplatelet medicine used to cut the risk of heart attacks and stent clots after acute coronary syndromes (ACS). Unlike older pills, it blocks the P2Y12 receptor reversibly and works quickly—so it’s often given with low‑dose aspirin after a heart event. Here’s what you need to know in plain language.

How it’s used and common dosing

For most people treated for ACS, the usual start is a 180 mg loading dose, then 90 mg twice daily. Many guidelines recommend continuing 90 mg twice daily for the first 12 months. After a year, some patients switch to 60 mg twice daily if long‑term therapy is needed—your cardiologist will decide if that’s right for you.

Ticagrelor is usually taken with low-dose aspirin (75–100 mg daily). Higher aspirin doses can reduce ticagrelor’s benefit, so don’t use aspirin over 100 mg without asking your doctor.

What to watch for: side effects and safety

The main risk is bleeding. Tell your doctor about any active bleeding, recent stroke, or bleeding disorders—ticagrelor shouldn’t be used if you have those. Common side effects include bleeding, shortness of breath (dyspnea), and sometimes slow heart rate or raised uric acid. Most dyspnea is mild and appears early, but report breathing trouble right away.

No routine platelet testing is needed, but your medical team will monitor for bleeding signs, especially after surgeries or dental work. If you need an invasive procedure, talk to your cardiologist about temporarily stopping ticagrelor.

Drug interactions matter. Strong CYP3A4 inhibitors (like ketoconazole or clarithromycin) can raise ticagrelor levels and increase bleeding risk. Strong CYP3A4 inducers (like rifampin) can lower its effect. Avoid high‑dose aspirin and be cautious with NSAIDs, anticoagulants, or other antiplatelet drugs—combine only under close medical supervision.

Special situations: severe liver disease is a no‑go for ticagrelor. Kidney problems don’t usually need dose changes, but bleeding risk still matters. If you’re switching between antiplatelet drugs, do it under a doctor’s guidance—timing and loading doses vary by drug.

Simple tips for everyday use: take ticagrelor twice daily at consistent times, carry a list of your meds and allergies, show it to any new clinician or dentist, and tell emergency staff you’re on an antiplatelet. If you notice unusual bruising, black stools, blood in urine, fainting, or severe shortness of breath—seek care fast.

Questions about interaction with over‑the‑counter meds or how long you’ll need to stay on ticagrelor? Ask your cardiologist or pharmacist. They’ll weigh your heart risk, bleeding risk, and other medicines to pick the safest plan for you.