5 foods to avoid while taking Brilinta

In this article:

• How Brilinta works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects

In this article

• How Brilinta works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects

Brilinta (ticagrelor) is a brand-name antiplatelet prescription drug that prevents blood clots. The drug has been approved by the Food and Drug Administration (FDA) to reduce the risk of heart attack, stroke, and cardiovascular death in people with acute coronary syndrome (ACS) or who have recently experienced a myocardial infarction (heart attack). Brilinta works best when used alongside a heart-healthy diet. It’s also essential to avoid grapefruit and certain over-the-counter supplements when taking Brilinta, as they can interfere with the drug’s effectiveness. 

How Brilinta works

Brilinta’s active ingredient, ticagrelor, prevents blood cells called platelets from sticking together to form clots. This thins the blood to help avoid clot-related problems such as stroke, heart attack, and other cardiovascular problems. Brilinta reaches its maximum concentration in the blood within 90 minutes of taking it and stays effective for several hours. Dosage ranges from 60 mg to 90 mg twice per day.

5 foods to avoid with Brilinta

Grapefruit is the only food that must be strictly avoided on Brilinta because of potential drug interactions. “It’s also best to avoid excessive alcohol, high-sodium foods, and high-fat foods,” says Jodie Pepin, Pharm.D., clinical pharmacy program manager at Harbor Health in Round Rock, Texas.

Aside from grapefruit, healthcare professionals recommend limiting a few specific food types and supplements that increase either the risk of bleeding or cardiovascular problems, including:

1. Grapefruit

It’s important not to take Brilinta with grapefruit, grapefruit juice, and other grapefruit products. That’s because grapefruit blocks an enzyme that helps your body metabolize the drug. 

“This can cause Brilinta to build up in your system, which may increase your risk of side effects, especially bleeding,” explains Tatiana Echeverry, MD, a board-certified internist with Medical Offices of Manhattan in New York, New York.

“Avoiding grapefruit helps keep your medication working safely and the way it’s intended to work,” emphasizes Dr. Pepin. It’s also a good idea to avoid drinking the following tropical juices, as they can affect the same CYP3A4 enzyme as grapefruit: kiwi, pineapple, papaya, lychee, starfruit, and passionfruit.

2. Excess alcohol

Individuals who frequently consume alcohol should limit their drinking while taking Brilinta. “Alcohol can thin the blood,” says Dr. Pepin. Drinking a lot of alcohol while also taking a blood thinner like Brilinta raises the risk of bleeding. She warns that the risk of severe bleeding is further increased if you take a dose of aspirin with Brilinta.

Drinking an occasional beer or glass of wine while taking Brilinta is fine for most patients. Moderate alcohol consumption is unlikely to increase the risk of side effects significantly, but excessive drinking increases the risk of bleeding, including nosebleeds and internal bleeding. “Limit or avoid depending on your medical history. Ask your provider for guidance,” says Dr. Pepin. The good news? There’s no need to avoid other favorite beverages like coffee.

3. High-sodium foods

It’s a good idea to avoid sodium-packed canned soups, deli meats, and salty packaged snacks like potato chips while on Brilinta. While sodium is an essential nutrient, the American College of Cardiology warns that too much of it causes high blood pressure, forcing the heart to work harder and increasing the risk of stroke.

Bottom line: While salt doesn’t directly interact with Brilinta, Dr. Pepin suggests cutting back because it can contribute to cardiovascular issues.

4. Fatty and fried foods

Foods high in saturated and trans fats are not good for your cholesterol or heart. Since Brilinta is prescribed for heart health, eating foods high in these unhealthy fats only undermines the treatment. Dr. Pepin recommends avoiding processed meats, fried foods, and packaged processed snacks. It’s a good idea to limit full-fat dairy (heavy cream and butter), cream-based salad dressings and pasta sauces, and fatty cuts of meat (such as beef with visible marbling). For specific fat intake guidelines, seek personalized medical advice from a healthcare provider or nutritionist.

5. Blood-thinning foods

Certain foods affect platelet aggregation, the process by which your blood cells clump together to form a clot. Meaning, they act as natural blood thinners. Typically, the effect isn’t strong enough to cause a problem, but when you eat them along with an anticoagulant, such as Brilinta, it can increase your bleeding risk. To stay on the safe side, avoid the following in large amounts:

• Ginger
• Cocoa
• Garlic
• Fish and fish oil

It’s okay to have these staple ingredients occasionally in small quantities, but eat them with caution—and advice from your provider.

Supplements to avoid

In addition to watching what you eat, it’s important to consider whether your daily supplements or vitamins may interact with Brilinta. Healthcare providers recommend avoiding the following supplements while taking this blood thinner:

• St. John’s wort: Drs. Echeverry and Pepin say that St. John’s wort reduces the effectiveness of Brilinta by activating a liver enzyme called CYP3A4 that helps the body metabolize Brilinta. “When this happens, your body may get rid of Brilinta too quickly—before it has a chance to work properly,” says Dr. Pepin.
• Saw palmetto: Dr. Echeverry says saw palmetto may also affect how the body metabolizes ticagrelor, the active ingredient in Brilinta. According to the Mayo Clinic, taking saw palmetto with Brilinta increases the risk of bleeding and bruising.  
• Ginkgo biloba: Gingko is an herbal supplement marketed as a treatment for various medical conditions, including blood disorders and memory problems. “Ginkgo biloba may increase the risk of bleeding, especially when combined with blood-thinning medications,” says Dr. Echeverry. 

It’s a good idea to tell your prescriber about any supplements or over-the-counter medications you take before taking a dose of Brilinta. This can help prevent serious side effects and other issues. For instance,  nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can increase the risk of bleeding while taking anticoagulants like Brilinta, warfarin, and Plavix. 

What should you eat while taking Brilinta?

People taking Brilinta should follow a heart-healthy diet. Heart-healthy foods include fruits and vegetables, whole grains, lean proteins, and healthy fats. The DASH diet, which stands for Dietary Approaches to Stop Hypertension, prioritizes plant foods with smaller portions of low-fat dairy, fish, and poultry. The DASH diet also emphasizes a low daily sodium intake. 

Ultimately, diet can play a significant role in supporting overall health after a heart attack or while living with coronary artery disease or other cardiovascular diseases. Dr. Pepin recommends asking your provider for advice on how to adjust your eating habits. Lifestyle changes for better heart health also include regular exercise and quitting smoking.

Gastrointestinal side effects of Brilinta

Like other prescription medications, Brilinta is not without side effects. The most common gut-related problems associated with Brilinta are diarrhea and nausea. Eating fatty or processed foods can exacerbate both.

Serious side effects and risks of Brilinta

Your diet will not affect the risk of serious side effects from Brilinta. However, it is still important to know the red flags of life-threatening side effects or allergic reactions.

Seek medical advice if you experience any of the following on Brilinta: 

• Shortness of breath
• Slow heart rhythm
• Irregular heartbeat

Seek urgent medical attention if you experience:

• Red or purple spots on skin accompanied by confusion, fatigue, or severe headache (signs of thrombotic thrombocytopenic purpura—TTP—a disorder in which blood clots form in small blood vessels)
• Signs of bleeding, including nosebleeds, brown urine, black stool, or vomit that looks like coffee grounds
• Signs of allergic reaction (trouble breathing, hives, swelling, dizziness, confusion).