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Compare Brilinta alternatives | Plavix | Effient | Aspirin | Cilostazol | Xarelto | Natural alternatives | How to switch meds
Brilinta (ticagrelor) could be a highly valuable component of your medication list. Treatment and prevention of a heart attack and stroke ranks at or near the top of most of our priority lists for what we want out of our medical care. Certain drug classes help us to achieve those goals. Cholesterol-lowering drugs, such as statins and antihypertensives for blood pressure control are well-known classes that do so. Antiplatelet agents are another category that has a significant role in the acute treatment of myocardial infarction (MI or heart attack) and stroke, as well as the prevention of these events. Platelets are our clotting cells and are involved in clot formation during MIs and strokes. As a potent antiplatelet agent, Brilinta can help you to avoid clots and maintain normal blood flow, steering you clear of these health complications. Despite the drug’s importance, you may still find yourself looking for alternatives, probably based on cost concerns or adverse effects. Our goal here will be to apprise you of other options to consider.
What can I take in place of Brilinta?
Amongst the antiplatelet agents, the members of the class vary in their cost, drug interactions, and Food and Drug Administration (FDA)-approved indications. The variability within the drug class can be a compelling reason to choose one over another or to make a change between antiplatelet agents. Less commonly, the direct oral anticoagulant Xarelto (rivaroxaban) can be used at a low dose for one of the same indications as Brilinta.
RELATED: Brilinta dosages
Compare Brilinta alternatives |
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|---|---|---|---|
| Drug name | Uses | Dosage | Coupons |
| Brilinta (ticagrelor) | Acute coronary syndrome (ACS), cardiovascular event prevention, coronary artery disease (CAD), acute ischemic stroke, transient ischemic attack (TIA) | 60 or 90 mg twice daily | Brilinta coupons |
| Plavix (clopidogrel) | ACS, thrombotic event prevention | 75 mg once daily | Plavix coupons |
| Effient (prasugrel) | ACS | 10 mg once daily | Effient coupons |
| Aspirin | ACS, MI prevention, TIA and thromboembolic stroke prevention | 75-325 mg once daily | Aspirin coupons |
| Aspirin-dipyridamole ER | Thrombotic stroke prevention | 25 mg/100 mg twice daily | Aspirin-dipyridamole ER coupons |
| Cilostazol | Intermittent claudication, secondary prevention of noncardioembolic stroke or TIA (off-label), percutaneous coronary intervention such as stent placement (off-label) | 100 mg twice daily | Cilostazol coupons |
| Low-dose Xarelto (rivaroxaban) | Cardiovascular event reduction, thrombotic event reduction | 2.5 mg twice daily | Xarelto coupons |
Top 5 Brilinta alternatives
1. Plavix
Plavix and Brilinta share the same mechanism of action. They both block the adenosine diphosphate (ADP) P2Y12 receptor on platelets, thereby preventing platelet aggregation. The inhibition of platelet clumping means less blood clotting, a result that can help to treat and prevent MIs and strokes. For the most part, the similarities between the two antiplatelet agents end there. Brilinta has its advantages of a faster onset and higher potency compared to Plavix, making Brilinta a favorite in the setting of acute MI. The potency may be a favorable characteristic for those who have genetic resistance to P2Y12 inhibitors. A shorter duration of action also makes Brilinta easier to stop in advance of surgery. Unlike Brilinta, Plavix may have reduced activity when used concurrently with the commonly used antacid class proton pump inhibitors (PPIs), like Prilosec (omeprazole).
Despite the beneficial effects of Brilinta, it has its drawbacks that may have you looking at Plavix as an alternative. Lower potency is likely the reason why Plavix has a lower risk of bleeding side effects, a difference that was found to be particularly important in seniors. Economically, Plavix is available in a less expensive generic form, clopidogrel, while Brilinta is not.
RELATED: What is Plavix?
2. Effient
Effient is another potent inhibitor of the ADP P2Y12 receptor, making it a close cousin of Brilinta and another favorite in the setting of acute MI due to fast onset and high potency. The list of FDA-approved indications for Effient is shorter than Brilinta. Nonetheless, it may have some advantages that spark your interest in changing from Brilinta. Effient was found to be more effective in a randomized clinical trial and in a post hoc analysis, both studies done in patients with acute coronary syndromes, a term for when blood supply to the heart is suddenly reduced. Keep in mind that these findings still need to be confirmed with further studies. Efficacy aside, Effient also avoids one of Brilinta’s common side effects, dyspnea or shortness of breath. It does not avoid the potential for bleeding events though, to the extent that both Effient and Brilinta have a black box warning as a disclaimer from the FDA about bleeding risk.
3. Aspirin/dipyridamole
At times, aspirin is an over-the-counter alternative to other antiplatelet drugs, but oftentimes, aspirin is used along with other platelet inhibitors. Dual antiplatelet therapy (DAPT) is a term referring to when aspirin is used alongside another antiplatelet agent such as Brilinta, Plavix, or Effient. DAPT is commonly instituted after coronary stents are placed and continued for a variable amount of time, typically at the discretion of a cardiology specialist. The role of DAPT in the short-term after a stroke is still being defined as well. While Brilinta and aspirin have been found to be effective for short-term use after a minor stroke, Plavix and aspirin are a more common choice based on cost and more research. Likewise, Brilinta is also not chosen for long-term protection against a second stroke due to a paucity of investigation on this use.
If you have had a stroke previously and are looking for an antiplatelet agent to help prevent another stroke, aspirin/dipyridamole could be a better option based on proven efficacy and an advantage over aspirin alone in this setting. Both aspirin and dipyridamole have antiplatelet effects, dipyridamole by blocking adenosine uptake by platelets and aspirin by inhibiting platelet cyclooxygenase. The combination aspirin/dipyridamole is only indicated for use in prevention of a second stroke and not for coronary event treatment or prevention, so this drug may not be a valid alternative to Brilinta for you if you have heart problems.
4. Cilostazol
Cilostazol is a brand-name drug that exerts an antiplatelet effect by inhibiting phosphodiesterase 3 and thereby decreasing platelet aggregation. The drug is FDA-indicated for intermittent claudication, leg pain that results from reduced circulation due to blockages in peripheral arteries. Off-label, it has also been used for the long-term prevention of a second stroke. This use for cilostazol may be based on supportive studies from Japan and China. However, studies have not proven this benefit in non-Asian ethnic groups, and like Brilinta, it does not have a FDA indication for secondary stroke prevention.
5. Xarelto
Xarelto does have an FDA-approved preventive indication. Xarelto is a direct oral anticoagulation, also known as a blood thinner, that works by preventing blood clots through inhibition of the factor Xa enzyme. It is best known for treatment of blood clots and prevention of strokes in those with atrial fibrillation. At a much lower dose than in these uses, Xarelto was studied in combination with aspirin and found to be effective for prevention of cardiovascular events, including strokes, in patients with known coronary artery disease or peripheral artery disease. If you have this disease history, low-dose Xarelto could be an alternative to Brilinta, which was combined with aspirin and found to be effective for cardiovascular event prevention in those with coronary heart disease and diabetes. When considering different options, keep in mind that combining two antiplatelet agents or combining an anticoagulation and an antiplatelet agent can create a higher risk of major bleeding.
Related: Is it safe to drink alcohol while taking blood thinners?
Natural alternatives to Brilinta
Efforts to prevent a second heart attack or stroke should include non-pharmacologic methods, in addition to prescription drugs. A healthy diet is recommended, including low salt intake. Weight loss can be beneficial. Smoking cessation is critically important.
Dietary supplements have generated interest regarding their potential to lessen the risk of cardiovascular events. Unfortunately, vitamin D and vitamin E supplementation have not been proven effective. Likewise, supplementing omega-3 fatty acids, or fish oil, was ineffective in lowering the risk of heart attacks.
RELATED: Is it safe to take Brilinta and drink caffeine?
How to switch to a Brilinta alternative
Typically, the stakes are high when Brilinta is in use. A heart attack or stroke could be unfolding or could be at high risk of recurring. For this reason, if you are considering stopping Brilinta or changing to another drug, you must consult with your healthcare provider for medical advice. Discuss what has prompted you to look for alternatives, review all your options, and take into consideration possible side effects. Brilinta does not require tapering off, but the prescribing healthcare professional should provide you with a detailed plan of how to change medication if you arrive at that conclusion. If the drug’s cost is your concern, try getting a SingleCare discount card and presenting it to your pharmacist for assistance.
