Brilinta dosage, forms, and strengths

Brilinta is a brand-name prescription drug used to decrease the risk of a heart attack or stroke in people who have coronary arteBrilinta is a brand-name prescription drug used to decrease the risk of a heart attack or stroke in people who have coronary artery disease, acute coronary syndrome, or a past experience with a heart attack or stroke. It can also be used to decrease the risk of blood clots after a stent placement.

Ticagrelor, the active ingredient in Brilinta, is an antiplatelet agent. It works by preventing platelets from clumping together and forming blood clots. Ticagrelor blocks platelet activity and the formation of blood clots to reduce the risk of stroke, heart attack, and other complications. 

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Brilinta forms and strengths

Ticagrelor is administered as a tablet.

• Tablets: 60 milligrams (mg), 90 mg

Brilinta dosage for adults

Brilinta prevents blood clotting and is prescribed to prevent heart or stroke in people who have experience with a recent heart attack, reduced blood flow to the heart (acute coronary syndrome), or an increased risk of a first-time heart attack or stroke. It is also used to prevent additional strokes in people who have just experienced a stroke or mini stroke (transient ischemic attack). Brilinta is typically prescribed with low-dose aspirin (75–100 mg) therapy.

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Brilinta dosage for acute coronary syndrome (ACS)

Acute coronary syndrome describes any event in which blood flow to the heart is blocked, starving the heart’s muscles of oxygen. ACS can cause chest tightness and chest pain, and it can even stop the heart. The most serious ACS event is a heart attack, or myocardial infarction (MI), which can cause part of the heart muscle to die. ACS events are caused by a blockage of blood flow from blood clots. People who have ACS or a history of MI are at high risk for a heart attack, stroke, or cardiovascular death caused by blood clots. 

Some people with ACS may need a medical device called a stent (or PCI) placed into an artery to keep it open and improve blood flow. A stent can cause blood clots (stent thrombosis) that can lead to an ischemic stroke or heart attack. Brilinta can be used to prevent blood clots in a stent. 

To prevent blood clots, Brilinta is administered immediately during emergency treatment for ACS and continued after the person leaves the hospital. It works as an antiplatelet agent that prevents platelet aggregation, the first step in blood clot formation. It attaches itself to a receptor involved with the activation of platelets—in essence, it hides their “on” switch from the chemical that activates that switch. 

• Standard dosage for acute coronary syndrome: 90 mg taken orally twice per day for one year, then 60 mg taken orally twice per day

• Additional information: A 75-100 mg dose of aspirin should be taken daily while on treatment with Brilinta

Brilinta dosage for coronary artery disease (CAD)

Coronary artery disease is diagnosed when plaque in the heart’s arteries has reduced blood flow to the heart. People with CAD are at an increased risk of heart attack or stroke due to blood clots. Brilinta is often prescribed to prevent blood clots in people with CAD and other risk factors for a heart attack, such as high blood pressure, high cholesterol, diabetes, or obesity. For people with CAD, Brilinta is taken twice a day with a daily maintenance dose of aspirin.

• Standard dosage for coronary artery disease: 60 mg taken orally twice per day

• Additional information: A 75-100 mg dose of aspirin should be taken daily while on treatment with Brilinta

Brilinta dosage for acute ischemic stroke and transient ischemic attack (TIA)

Both ischemic strokes and transient ischemic attacks—often called “mini strokes”—occur when blood flow to the brain is blocked by plaque or a blood clot. They differ, however, in severity. Ischemic strokes inevitably involve cell death in the brain and cause permanent brain damage. TIAs, on the other hand, may cause symptoms of an ischemic stroke, but symptoms are temporary without causing permanent damage. Both strokes and TIAs, however, carry a high risk for additional blood clot (thrombotic) events, such as a heart attack or additional strokes. 

Brilinta is used to prevent blood clots when people are initially treated for stroke or TIA. Discontinuation of Brilinta treatment will occur in 30 days or less when the risk for further thrombotic events has passed. As with other indications, Brilinta is taken twice per day with a daily low-dose aspirin. An initial loading dose of Brilinta is given, which is twice that of a normal dose.

• Starting dosage: 180 mg as the initial loading dose along with 300-325 mg of aspirin

• Standard dosage for ischemic stroke and TIA: 90 mg taken orally twice per day for up to 30 days

• Additional information: A 75-100 mg dose of aspirin should be taken daily while on treatment with Brilinta

Brilinta dosage for children

The U.S. Food and Drug Administration (FDA) has not approved Brilinta for use in children or adolescents younger than 18 years of age.

Brilinta dosage restrictions

Brilinta, like all blood thinners, is a potentially hazardous drug that may not be right for everyone. People with an active bleeding problem, such as a stomach ulcer, or a history of brain bleeding should not use Brilinta. Likewise, people who are allergic to the drug or undergoing coronary artery bypass graft (CABG) surgery should also avoid the use of Brilinta.

The dosage of Brilinta does not need to be adjusted in people with kidney problems or mild liver disease. However, you should avoid using Brilinta if you have severe liver problems. Taking Brilinta with severe liver disease can increase the risk of bleeding problems.

How to take Brilinta

Brilinta is taken as a tablet with or without food twice per day along with a single maintenance dose of aspirin taken once per day.

• Take Brilinta twice per day as directed by a healthcare provider.

• Take each Brilinta dose at about the same time every day.

• Swallow the Brilinta tablet whole. 

• People with trouble swallowing can crush the tablet and mix it with water. Drink the mixture immediately, and then refill and drink a full glass of water. 

• Store Brilinta at room temperature (68°–77° F) and keep out of the reach of children.

• This medicine should come with a medication guide that contains information about potential side effects to watch out for and how to handle them. Please read this guide before taking this medicine.

Brilinta dosage FAQs

How long does it take Brilinta to work?

Ticagrelor, the active ingredient in Brilinta, prevents platelets from sticking together to form a blood clot. A dose of ticagrelor starts working right away and reaches its maximum concentration in the blood in about one and a half hours. However, the drug produces maximum inhibition of platelet aggregation in two hours, and its effects continue for about eight hours.

How long does Brilinta stay in your system?

Ticagrelor has a terminal half-life of seven hours. However, the active metabolite of the drug has a half-life of nine hours. Studies have shown it may take up to five days for a dose of ticagrelor to lose its ability to inhibit platelet aggregation.

What happens if I miss a dose of Brilinta?

If a Brilinta dose is forgotten, skip the missed dose and take the next dose as scheduled. Do not take extra tablets to make up for a missed dose.

What interacts with Brilinta?

Combining Brilinta with other drugs, even seemingly harmless drugs like over-the-counter medicines, dietary supplements, or herbal supplements, can cause problems. When getting a prescription for a drug like Brilinta, have a complete list of other drugs and supplements you are currently taking and share that list with the prescribing healthcare provider and the pharmacist. 

An increased risk of bleeding is the most common adverse effect of Brilinta, and major bleeding episodes are potentially life-threatening. Brilinta’s most hazardous drug interactions involve drugs that also interfere with the body’s ability to form blood clots. Drugs that can interfere with blood clotting include anticoagulants such as clopidogrel, aspirin or aspirin-containing products, nonsteroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs).

Other drugs can affect the body’s ability to break down ticagrelor, which can cause the drug to stay in the body for longer and at higher concentrations. CYP3A4 inhibitors are drugs that can lead to increased levels of ticagrelor in the blood. Taking ticagrelor with CYP3A4 inhibitors can increase the risk of bleeding or other ticagrelor side effects, such as shortness of breath (dyspnea). The most well-known CYP3A4 inhibitors include grapefruit and grapefruit juice; certain antibiotics, such as clarithromycin and telithromycin; certain HIV-AIDS drugs, such atazanavir; certain blood pressure medications, such as diltiazem and verapamil; and certain antifungal medications, including ketoconazole and itraconazole. 

Other drugs, called CYP3A4 inducers, speed up the body’s metabolism of ticagrelor, making it less effective and raising the risk of blood clots. Strong CYP3A4 inducers include certain anti-seizure medications, like phenytoin and carbamazepine; certain antibiotics, like rifampin; and barbiturates, such as phenobarbital.

Before taking Brilinta, you should tell your healthcare provider if you are also taking opioids, statin drugs (particularly simvastatin and lovastatin), or digoxin.

What happens when you mix Brilinta and alcohol?

Neither the manufacturer, AstraZeneca, nor the FDA directly cautions against the use of alcohol while taking Brilinta. A healthcare provider, however, will likely advise against drinking excessively while on antiplatelet therapy with Brilinta and aspirin. Combining alcohol and aspirin raises the risk of stomach bleeding, and bleeding events are a serious side effect of Brilinta.

Is it safe to take Brilinta during pregnancy?

There are no studies on the effects of ticagrelor on pregnant women or an unborn fetus. Women who are pregnant or planning pregnancy should seek medical advice from a healthcare professional about the risks and benefits of taking Brilinta before starting treatment.

There is no research on the safety of Brilinta when breastfeeding an infant. Ticagrelor may pass into breast milk, which could potentially lead to adverse effects in an infant. Therefore, doctors don’t usually recommend breastfeeding while on Brilinta. 

Sources:

• Brilinta prescribing information, U.S. National Library of Medicine

• Brilinta safety information, AstraZeneca

• Ticagrelor compound summary, U.S. National Library of Medicine

• Ticagrelor drug summary, Prescriber’s Digital Reference