Brilinta vs. Plavix: Differences, similarities, and which is better for you

In this article:

• Main differences
• Conditions
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

Brilinta (ticagrelor) and Plavix (clopidogrel) are antiplatelet medications, which are a type of blood thinner. More specifically, they work as P2Y12 inhibitors to prevent harmful blood clots with acute coronary syndrome (ACS). These medicines are usually prescribed for at least a year after an event like a heart attack and are taken with a low-dose aspirin as part of dual antiplatelet therapy (DAPT).

Main differences between Brilinta vs. Plavix
	Brilinta	Plavix
Drug class	Antiplatelet  P2Y12 inhibitor	Antiplatelet P2Y12 inhibitor
Brand/generic status	Brand and generic versions available	Brand and generic versions available
What is the generic name?	Ticagrelor	Clopidogrel
What form(s) does the drug come in?	Oral tablet	Oral tablet
What is the standard dosage for acute coronary syndrome?	Initial loading dose of 180 mg. Then, 90 mg twice daily for the first year after an ACS event. Then, 60 mg twice daily thereafter.	Initial loading dose of 300 mg. Then, 75 mg once daily.
How long is the typical treatment?	12 months or longer	12 months or longer
Who typically uses the medication?	Adults 18 years and older	Adults 18 years and older

What are the main differences between Brilinta and Plavix?

Brilinta 

Brilinta is the brand name for ticagrelor. It’s also available as a generic version and is typically taken twice daily as a pill alongside daily aspirin. 

According to guidelines from the American College of Cardiology/American Heart Association Joint Committee, Brilinta is one of the preferred treatments for people with ACS. It works faster than Plavix and has a reversible effect, which means its action wears off sooner once stopped. 

Plavix

Plavix is the brand name for clopidogrel. It has been around longer than Brilinta and is a once-daily pill. Like Brilinta, it’s also taken with aspirin to reduce blood clots.

One important difference is that Plavix is a prodrug that needs to be activated in the liver by the CYP2C19 enzyme. People who are CYP2C19 poor metabolizers convert less of the drug to its active form, so it may be less effective for some. Healthcare providers may recommend genetic testing or an alternative medication if Plavix isn’t working as expected.

Conditions treated by Brilinta and Plavix

Both medications are FDA-approved to reduce the rate of cardiovascular events in people with ACS. These events may include heart attacks, stroke, unstable angina (sudden, worsening chest pain), and other heart-related conditions. 

Both medications may help prevent two major types of heart attacks:

• ST-elevation myocardial infarction (STEMI): A more severe type of heart attack caused by a complete blockage of a heart artery.
• Non-ST-elevation myocardial infarction (NSTEMI): A heart attack caused by a partial blockage or narrowing of a heart artery.

Although both are medical emergencies, STEMIs often require immediate revascularization, such as placing a stent to open the blocked artery. NSTEMIs can sometimes be managed with medication alone, but a stent may be needed in severe cases. 

After a stent placement, also known as a percutaneous coronary intervention, there is a high risk of stent thrombosis, or blood clots forming. Brilinta or Plavix, alongside aspirin, can reduce platelet aggregation and prevent blood clots around the stent.

Is Brilinta or Plavix more effective?

Brilinta and Plavix are both effective at lowering the risk of blood clots after a heart attack or stroke. Clinical trials suggest Brilinta may be more effective than Plavix, though it also carries a higher bleeding risk.

In a large study called the PLATO trial, Brilinta lowered the risk of cardiovascular death, heart attacks, and strokes more than Plavix. After one year, around 10% of people on Brilinta had died from vascular problems, had a heart attack, or had a stroke, versus around 12% on Plavix. However, people taking Brilinta also had a higher risk of bleeding events.

A more recent systematic review and meta-analysis that included nearly 166,000 ACS patients supported these findings. Brilinta reduced the overall rate of major adverse cardiovascular events and lowered the risk of stroke and all-cause death more than Plavix. At the same time, however, Brilinta was linked to an increased risk of major and minor bleeding events.

In any case, it’s important to consult a healthcare provider for the best treatment option. 

Coverage and cost comparison of Brilinta vs. Plavix

Brilinta is usually covered by most commercial insurance and Medicare Part D plans. A generic version is also available, which can help bring down costs. The average retail cost of a 30-day supply of 90 mg tablets is around $663. However, a SingleCare card could lower that cost to under $30.

Most Medicare and commercial insurance plans also cover Plavix, which is available as a generic. The average retail cost of brand-name Plavix is around $641 for a 30-day supply of 75 mg tablets. However, a Plavix SingleCare discount card may help bring the generic cost down to around $4, depending on the pharmacy.

Comparing the cost of Brilinta vs. Plavix
	Brilinta	Plavix
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare?	Yes	Yes
Quantity	60, 90 mg tablets	30, 75 mg tablets
Typical Medicare copay	Varies	Varies
SingleCare cost	$29	$4

Common side effects of Brilinta vs. Plavix

The most common side effect of Brilinta and Plavix is bleeding. Minor bleeding can include symptoms such as easy bruising, bleeding gums, or nosebleeds, while major bleeding events include blood in the urine or stool and vomiting blood. Symptoms of major bleeding could mean internal bleeding and may need medical attention.

Although they both can cause bleeding, Brilinta and Plavix may differ in their risk of these side effects. Studies show Brilinta has higher rates of minor and major bleeding events than Plavix. It’s also linked to shortness of breath (dyspnea), which isn’t known to occur with Plavex. 

Drug interactions of Brilinta and Plavix

Brilinta and Plavix can interact with several medications. Taking either drug with NSAIDs like ibuprofen or naproxen, anticoagulants such as warfarin, and certain antidepressants like SSRIs and SNRIs can increase the risk of bleeding. Opioids can also make either drug less effective by decreasing how much of them the body absorbs.

Brilinta may also interact with the following:

• CYP3A4 inhibitors: Drugs like ketoconazole, clarithromycin, and certain antivirals can increase Brilinta levels in the body, which may increase the side effects of Brilinta.
• CYP3A4 inducers: Medications such as rifampin, phenytoin, and carbamazepine can lower Brilinta levels, making the drug less effective.
• Statins: Higher doses of lovastatin, or simvastatin, and even rosuvastatin, may build up in the body when taken with Brilinta, increasing the risk of muscle-related side effects.
• Digoxin: Brilinta can increase digoxin levels, which may lead to serious side effects of digoxin.

Plavix may also interact with the following:

• CYP2C19 inducers: Drugs like rifampin can speed up how Plavix is broken down into its active form, increasing the amount of active Plavix in the body and amplifying the risk of bleeding. 
• CYP2C19 inhibitors: Medications such as omeprazole and esomeprazole can block the CYP2C19 enzyme, reducing the amount of active Plavix in the body and making Plavix less effective.
• Repaglinide: Plavix can increase the effects of repaglinide, raising the risk of low blood sugar.

Warnings of Brilinta and Plavix

Brilinta and Plavix come with similar warnings and precautions, including an increased risk of bleeding, which may be fatal in severe cases. In addition, discontinuing Brilinta and Plavix may increase the risk of cardiovascular events like heart attacks and strokes. Allergic reactions are also possible with either drug and may cause symptoms such as rash, hives, trouble breathing, and swelling of the face or throat.

Other warnings of Brilinta include:

• Shortness of breath is common with Brilinta. It’s usually mild and may go away, but it can sometimes be severe enough to stop the medication.
• Brilinta can cause slow or irregular heartbeats (bradyarrhythmia). People with existing heart rhythm problems may be at higher risk.
• People with severe liver problems should not take Brilinta. The drug can build up in the body and increase the risk of side effects.
• Central sleep apnea (a condition where breathing stops and starts during sleep) has been reported in some people taking Brilinta. This can sometimes return or worsen if the drug is restarted.
• Brilinta can interfere with certain lab tests for heparin-induced thrombocytopenia (HIT), a rare blood reaction that sometimes causes false negative results.

Other warnings of Plavix include:

• Some people don’t process Plavix well due to genetic differences in the CYP2C19 enzyme, making the drug less effective at preventing blood clots.
• A rare but serious condition called thrombotic thrombocytopenic purpura (TTP) has been reported in people taking Plavix, sometimes within just a couple of weeks. TTP can cause low platelets, anemia, kidney problems, fever, and neurological symptoms.

It’s important to consult a healthcare provider about the potential warnings and precautions of antiplatelet drugs. 

Frequently asked questions about Brilinta vs. Plavix

Are Brilinta and Plavix the same?

No. Brilinta and Plavix are not the same. They are taken in different ways and have some differences in side effects and drug interactions. 

Is Brilinta or Plavix better?

Brilinta is considered a more effective drug than Plavix. It has been shown to be a better drug for reducing rates of cardiovascular death and preventing heart attack or stroke. However, it may be more likely to cause adverse effects such as bleeding and shortness of breath. Still, based on AHA and ACC guidelines, Brilinta is a preferred treatment over Plavix. 

Can I use Brilinta or Plavix while pregnant?

There is not enough data to show that Brilinta and Plavix are completely safe during pregnancy. These drugs are not generally recommended unless their benefits outweigh the risks. It’s best to consult a healthcare provider about treatment options while pregnant. 

Can I use Brilinta or Plavix with alcohol?

It is recommended to avoid drinking alcohol while taking blood thinners like Brilinta or Plavix. This is because alcohol also has blood-thinning properties. Drinking alcohol can compound the effects of these drugs and increase the risk of serious bleeding. 

How long do you have to take Brilinta after a stent?

Brilinta is usually taken for at least 12 months after a stent placement. After the first 12 months, Brilinta should be taken for an additional 12 months at a lower dose. A healthcare provider will evaluate a person’s condition at follow-up visits to determine how long they should be on Brilinta. 

Can you ever stop taking Brilinta?

Treatment with Brilinta is usually considered long-term. A healthcare provider may want to stop Brilinta in those who tolerate it poorly or experience adverse effects. The discontinuation of Brilinta too soon may increase the risk of heart attack or stroke in those with coronary artery disease. 

Which is safer, Brilinta or Plavix?

Brilinta and Plavix are generally comparable in terms of safety and effectiveness. However, Brilinta has been shown to cause more bleeding and shortness of breath than Plavix. To decrease the risk of bleeding, both drugs should be avoided with other blood thinners.