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

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Brilinta (ticagrelor) and Plavix (clopidogrel) are two treatment options to prevent the formation of blood clots. In people with acute coronary syndrome (ACS) or a history of myocardial infarction (MI, or heart attack), blood clots can clump together and block coronary blood flow. Medications like Brilinta or Plavix can ensure adequate blood flow around the heart to help prevent a heart attack or stroke.

Brilinta and Plavix are part of a group of medications called antiplatelet agents, blood thinners, or P2Y12 inhibitors. Both drugs work as receptor antagonists, which means they block the P2Y12 receptor responsible for promoting platelets and blood clots. These drugs are usually taken on a daily basis for at least a year after an ACS event.

While Brilinta is known to be a more effective drug in most cases, both drugs have important differences in side effects and dosage.

What are the main differences between Brilinta and Plavix?

Brilinta

Brilinta (What is Brilinta?) is the brand name for ticagrelor. Although a generic version has been approved, it is not yet commercially available. Therefore, this drug may be more expensive than Plavix or other similar agents like Effient (prasugrel).

According to the American Heart Association (AHA) and American College of Cardiology (ACC), Brilinta is a preferred treatment for people with ACS. Brilinta works faster and has a reversible mode of action. It also has better platelet inhibition and patient outcomes compared to Plavix.

Brilinta is taken as a twice-daily pill along with a daily aspirin.

Plavix

Plavix (What is Plavix?) is the brand name for clopidogrel. Unlike Brilinta, Plavix is currently available as a generic drug. Generic Plavix is generally a cheaper option as a blood thinner.

Plavix is taken as a once-daily pill. It is also taken with an aspirin to further reduce the risk of ACS events.

Some people may be considered poor metabolizers of Plavix due to genetic differences in certain liver enzymes. Those who are CYP2C19 poor metabolizers can’t process Plavix effectively and may need to use a different treatment.

Main differences between Brilinta and Plavix
Brilinta Plavix
Drug class Antiplatelet
P2Y12 inhibitor
Antiplatelet
P2Y12 inhibitor
Brand/generic status Brand name only Brand and generic version available
What is the generic name? Ticagrelor Clopidogrel
What form does the drug come in? Oral tablet Oral tablet
What is the standard dosage? Acute coronary syndrome (ACS):
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.
Acute coronary syndrome (ACS):
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

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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 (chest pain caused by factors that may lead to a heart attack), and other heart-related conditions.

Both drugs help prevent two types of heart attacks: ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). A STEMI occurs when the artery of the heart is completely blocked. A NSTEMI is caused by a partial blockage or narrowing of the heart artery.

While both forms of heart attacks are serious, a STEMI will often require revascularization, or the placement of a stent to open up the artery. NSTEMIs can often be treated with blood-thinning agents, although a stent is also required in severe cases.

There is a high risk of stent thrombosis, or blood clots forming after a stent placement, also known as a percutaneous coronary intervention. In order to prevent thrombosis, Brilinta or Plavix can be used to reduce platelet aggregation and prevent blood clots around the stent.

If you are prescribed Brilinta or Plavix, you will almost always be prescribed a daily aspirin. Aspirin is taken in combination with these drugs to further prevent blood clots. The combination of an aspirin and a P2Y12 inhibitor is called dual antiplatelet therapy (DAPT).

Condition Brilinta Plavix
Acute coronary syndrome (ACS) Yes Yes
Heart attack and stroke (prevention) Yes Yes

Is Brilinta or Plavix more effective?

Brilinta and Plavix have both been shown to be effective for reducing the risk of heart problems after experiencing a heart attack, stroke, or other heart disease-related events. However, clinical trials have shown that Brilinta is more effective than Plavix.

Based on a double-blind, randomized clinical study called the PLATO trial, Brilinta was found to reduce the rate of cardiovascular death compared to Plavix. After 12 months of treatment, death from vascular causes, heart attack, or stroke occurred in 9.8% of subjects receiving ticagrelor versus 11.7% of those receiving clopidogrel. However, after reviewing study endpoints, PLATO investigators found that there was a higher rate of certain bleeding events in the ticagrelor group compared to the clopidogrel group.

A meta-analysis that pooled more than 10 clinical studies showed that ticagrelor and clopidogrel were similar in efficacy and safety. There were no significant differences found between the two drugs. Those taking ticagrelor were found to experience more shortness of breath compared to clopidogrel.

Consult a doctor to find out whether Brilinta or Plavix is a better option for you.

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Coverage and cost comparison of Brilinta vs. Plavix

For people who are Medicare Part D patients, Brilinta is usually covered. Most insurance plans will also cover Brilinta. As of 2018, a generic version of Brilinta has been approved by the FDA. However, it is not commercially available yet. The average cost of Brilinta is over $500 for 60 90 mg tablets. Using a SingleCare discount card can lower the cost to less than $350.

Since Plavix comes as a generic drug, it can often be found at a cheaper price. Most Medicare and insurance plans will cover this drug. Still, the average retail cost of brand name Plavix is well over $200 for thirty 75 mg tablets. A Plavix SingleCare discount card can bring the generic cost down to $15 depending on the pharmacy you use.

Brilinta Plavix
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage 90 mg tablets (quantity of 60) 75 mg tablets (quantity of 30)
Typical Medicare copay $19–$423 $0–$19
SingleCare cost $350-$390 $15+

Common side effects of Brilinta vs. Plavix

The most common side effect of Brilinta and Plavix is bleeding. Minor bleeding can include easy bruising, bleeding gums, or nosebleeds. Major bleeding events include internal bleeding, blood in the urine or stool, and vomiting blood. Immediate medical attention is needed if you experience major bleeding.

Other side effects of Brilinta and Plavix include shortness of breath (dyspnea), dizziness, nausea, and diarrhea.

Side effects of bleeding and shortness of breath are often associated more with Brilinta compared to Plavix. According to some comparative studies, Brilinta produced more bleeding—both minor and major events—than Plavix.

Fortunately, an antidote has been developed to reverse the effects of Brilinta in severe cases of bleeding. Since Plavix is an irreversible inhibitor, it does not have a specific antidote to reverse its effects.

  Brilinta Plavix
Side Effect Applicable? Frequency Applicable? Frequency
Bleeding Yes 7.7% Yes 6.2%
Shortness of breath Yes 13.8% Yes 7.8%
Dizziness Yes 4.5% Yes 3.9%
Nausea Yes 4.3% Yes 3.8%
Diarrhea Yes 3.3% Yes 2.5%

This may not be a complete list. Consult your doctor or pharmacist for possible side effects.
Source: DailyMed (Brilinta), DailyMed (Plavix)

Drug interactions of Brilinta and Plavix

Opioids and CYP3A4 inducers reduce the metabolism or processing of Brilinta or Plavix in the body. This interaction can lead to decreased levels of Brilinta or Plavix, which can decrease how well they work.

CYP3A4 inhibitors and CYP3A4 inducers may alter blood levels of Brilinta or Plavix. CYP3A4 inhibitors include antifungals like ketoconazole and antibiotics like clarithromycin. CYP3A4 inducers include drugs like rifampin, phenytoin, and carbamazepine.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants like warfarin have blood-thinning properties. Taking these together can increase the risk of bleeding.

Brilinta can interact with statin medications and increase their side effects. Although Plavix may interact with statins, there is no solid evidence to suggest that Plavix interferes with statin therapy. In fact, studies have shown that statins can be helpful to further reduce the risk of death in people with ACS.

Drug Drug Class Brilinta Plavix
Morphine
Oxycodone
Hydrocodone
Opioids Yes Yes
Ketoconazole
Itraconazole
Clarithromycin
Ritonavir
CYP3A4 inducers Yes Yes
Rifampin
Phenytoin
Carbamazepine
Phenobarbital
CYP3A4 inhibitors Yes Yes
Celecoxib
Diclofenac
Ibuprofen
NSAIDs Yes Yes
Warfarin Anticoagulants Yes Yes
Simvastatin
Lovastatin
Statins Yes No
Digoxin Cardiac glycoside Yes No
Omeprazole
Esomeprazole
CYP2C19 inhibitors No Yes
Repaglinide Antidiabetic No Yes

This may not be a complete list of all possible drug interactions. Consult a doctor with all the medications you may be taking.

Warnings of Brilinta and Plavix

Both Brilinta and Plavix have a higher risk of bleeding associated with their use. Especially when combined with other blood-thinning drugs, Brilinta or Plavix can increase the risk of internal bleeding, such as intracranial hemorrhage or gastrointestinal bleeding. The use of antiplatelet agents like Brilinta and Plavix is cautioned if you have a known history of bleeding or ulcers.

Brilinta should not be started in patients undergoing a coronary artery bypass graft surgery (CABG). However, if bleeding can be managed during this procedure, it may be recommended to continue Brilinta treatment.

Brilinta should not be taken with aspirin doses greater than 100 mg. Higher doses of aspirin may decrease how well Brilinta works.

People who have a genetic dysfunction with CYP2C19 liver enzymes can experience reduced effectiveness with Plavix. This is because Plavix is mainly processed by the CYP2C19 enzyme. If you are suspected to be a CYP2C19 poor metabolizer, you can take a test to find out. You may be recommended a different drug if your body doesn’t process Plavix well enough.

Frequently asked questions about Brilinta vs. Plavix

What is Brilinta?

Brilinta is a prescription antiplatelet medication that is used to treat people with acute coronary syndrome (ACS). Also known by its generic name ticagrelor, Brilinta is taken twice daily to prevent the formation of blood clots. Brilinta is manufactured by AstraZeneca.

What is Plavix?

Plavix is an antiplatelet medication that is taken as a once-daily tablet for people with ACS. Plavix is available as a brand-name and generic version. Like Brilinta and other P2Y12 inhibitors, Plavix is taken with a daily aspirin. Plavix is manufactured by Bristol-Myers Squibb and Sanofi Pharmaceuticals.

Are Brilinta and Plavix the same?

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

Is Brilinta or Plavix better?

Brilinta has been marketed and studied as 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 produce adverse effects such as bleeding and shortness of breath. 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. Talk to your doctor about your available treatment options while pregnant.

Can I use Brilinta or Plavix with alcohol?

It is best 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 taken for at least 12 months after a stent placement, also known as a percutaneous coronary intervention. After the first 12 months, Brilinta should be taken for an additional 12 months at a lower dose. Your doctor will evaluate your condition at your follow-up visits to determine how long you should be on Brilinta.

Can you ever stop taking Brilinta?

Treatment with Brilinta is usually considered long-term. Your doctor may want to stop Brilinta if you are tolerating it poorly or experiencing adverse effects. Discontinuation of Brilinta too soon can increase the risk of heart attack or stroke if you have ACS or 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 compared to Plavix. Both drugs should be avoided with other blood thinners to decrease the risk of adverse effects.