Brilinta side effects and how to avoid them

Brilinta side effects include shortness of breath, serum creatinine elevation, and bleeding

By Chad Shaffer, MD | Dec. 5, 2021

Platelets are cells that circulate through our blood stream, on patrol for any need to stop bleeding. When a blood vessel is broken and bleeding starts, platelets are part of a multifaceted approach to stop the bleeding. Platelets in the area of hemorrhage produce agonist substances, such as adenosine diphosphate (ADP), that activate other platelets, which then begin to stick together and form a clot.

While the clotting system is nice to have when needed, it can be counterproductive in other times, namely during heart problems like myocardial infarction (MI [heart attack]) and cerebrovascular accidents (CVAs [strokes]), as well as in the presence of a vascular stent (artificial device placed within a blood vessel that hold it open). Fortunately, a variety of pharmacologic options exist to inhibit the clotting mechanisms, when prevention of clots within stents, coronary arteries to the heart, or cerebral arteries to the brain is paramount.

Brilinta (ticagrelor) is an example of a brand-name anticoagulant (blood thinner). By blocking the P2Y12 receptor for ADP, it serves a critical role in treating and preventing heart attacks and strokes. The risk of Brilinta and other blood thinners is that bleeding could occur. We will examine that risk in this article and review other Brilinta side effects.

RELATED: What is Brilinta?

Common side effects of Brilinta

Dyspnea (shortness of breath or trouble breathing)
Bleeding
Elevation of serum creatinine (blood test marker of kidney function)
Diarrhea
Dizziness
Nausea

Shortness of breath

Dyspnea is a term that refers to feeling short of breath or feeling like breathing is labored. One of the most common adverse effects of Brilinta, the feeling of shortness of breath, is experienced by 14% of patients taking it, according to the manufacturer AstraZeneca. The occurrence can be troublesome because dyspnea can be a symptom of an acute coronary syndrome, angina, or impending heart attack. A healthcare professional should be notified if dyspnea is experienced in order to determine the cause. Shortness of breath resulting from Brilinta resolves when the drug is discontinued.

Serum creatinine elevation

Serum creatinine is measured in blood tests as a marker for renal (kidney) function. For unknown reasons, it is elevated in 4% to 8% of patients taking Brilinta. The incidence was equal to aspirin in the PEGASUS study and greater than another P2Y12 inhibitor, Plavix (clopidogrel), in the PLATO study. The creatinine level improves when the medication is stopped and improves many times even if the drug is continued.

Serious side effects of Brilinta

Hypersensitivity allergic reaction
Severe or serious bleeding
Bradyarrhythmia (abnormally slow heart rate)
Atrioventricular block (slowing or absence of electrical conduction between the top and bottom chambers of the heart)
Thrombotic thrombocytopenic purpura or TTP (a life-threatening condition in which blood clots form within small blood vessels throughout the body)
Central sleep apnea (periods of slowing and cessation of breathing while sleeping due to a neurologic cause)

Severe bleeding

The aforementioned PLATO study examined the use of Brilinta in the setting of acute coronary syndrome (ACS), which is typified by chest pain from a reduction in blood flow to the heart related to coronary artery disease. The incidence rate of bleeding was about 8% in patients who did not require coronary artery bypass grafting (CABG surgery) for their cause of ACS. About half of these bleeding events were major, including about 2% of patients having life-threatening or fatal hemorrhage. Bleeding rates were substantially higher for those who required CABG surgery.

The PEGASUS study provided additional information on the increased risk of bleeding from Brilinta. In this clinical trial, subjects took Brilinta and aspirin or aspirin alone as part of a preventive strategy to reduce the risk of having another heart attack. The clinical trial found that 2.4% of patients taking both drugs experienced a bleeding event compared to 1% of patients taking aspirin alone.

Long-term effects of Brilinta

More data on long-term use and effects of Brilinta is needed. The PEGASUS study followed patients for three years. While bleeding rates were higher in those taking Brilinta and aspirin compared to aspirin alone, the rates of fatal bleeding, intracranial hemorrhage, and death from any cause were no different.

How long do Brilinta side effects last?

Some of the common side effects, such as dyspnea or diarrhea, can be expected to resolve soon after stoppage of the medication. An elevation of serum creatinine may improve while still taking Brilinta. Bleeding, however, may persist after stopping the drug, because some degree of inhibition of platelet aggregation related to Brilinta can last for five days. Of note, it has a faster onset and quicker offset of action than Plavix. Other serious possible side effects of Brilinta, such as allergic reactions, could also persist after discontinuation. Each of the serious side effects deserves emergency medical attention.

Brilinta contraindications and warnings

Brilinta is not habit-forming and does not elicit a withdrawal syndrome upon stopping. Based on a potentially higher risk of heart attack or stroke after stoppage, discontinuation of the drug should only be done in consultation with a healthcare profession.

The maximum single dose of Brilinta is 160 mg. This is only done as a loading dose in the setting of an ACS, stroke, or transient ischemic attack (TIA or temporary stroke symptoms without neurologic damage). An overdose of Brilinta should prompt emergent treatment and a call to the Poison Helpline at 1-800-222-1222.

Brilinta use is contraindicated in anyone with a history of hypersensitivity allergic reaction to it or a member of its drug class. In addition, it should not be taken by anyone with active bleeding, a history of intracranial hemorrhage, or severe hepatic (liver) impairment. The setting of upcoming CABG surgery raises particular concern for bleeding. Seniors can use Brilinta, but bleeding risk could be heightened. The FDA has not approved Brilinta for use in children. Given the lack of safety data, Brilinta is not recommended during pregnancy or breastfeeding.

Brilinta interactions

There is an extensive list of drug interactions with Brilinta. The importance of reviewing your prescription drugs, over-the-counter medications, and supplements with the prescribing provider cannot be overstated. The following list highlights some of the important interactions.

Anticoagulants (blood thinners) such as warfarin
Antiplatelet agents such as Plavix
Drugs or foods which interact with the p-glycoprotein or CYP3A4 enzyme, such as grapefruit, ritonavir, atazanavir, digoxin, carbamazepine, phenytoin, phenobarbital, simvastatin, lovastatin, ketoconazole, itraconazole, and rifampin
Drugs that also cause bradycardia or AV block
Drugs that cause delayed gastric (stomach) emptying

How to avoid Brilinta side effects

Fully discuss your medical conditions, health history, and current medications and supplements with the prescribing healthcare provider prior to starting Brilinta. Update the provider with any changes to medications or health status. Check with them before taking over-counter-medications, as common ones like ibuprofen can increase bleeding risk.
Immediately report any bleeding to a healthcare professional or seek medical attention. Signs of bleeding may not always be obvious and could include nosebleeds, brown urine, black stool, or vomiting material that looks like coffee grounds.
Take Brilinta exactly as prescribed. Follow instructions for taking Brilinta found in your medication guide. Continue to follow up with the prescribing provider to ensure that you are to continue the drug. Before discontinuing the medication, seek the medical advice of the provider.
Avoid alcohol use, since it may increase the risk of stomach bleeding.
If a dose is missed, skip the missed dose and simply take the next dose. Do not take both doses simultaneously.