Brilinta

When Brilinta (Ticagrelor) is used to prevent clotting for people with acute coronary syndrome (ACS), the usual starting dose of Brilinta (Ticagrelor) is 180 mg (two 90 mg tablets) for one dose, then 90 mg twice a day.

When Brilinta (Ticagrelor) is used to prevent clotting for people with a history of heart attack that occurred more than 1 year in the past, the recommended dose is 60 mg taken by mouth 2 times a day.

When Brilinta (Ticagrelor) is used to prevent clotting for people who have no history of heart attack, but who have Coronary Artery Disease and type 2 diabetes and have had a procedure to open a narrowed or blocked blood vessel, the recommended dose is 60 mg taken by mouth 2 times a day.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Brilinta (Ticagrelor) may be taken with or without food and should be swallowed whole with water. For people that are unable to swallow tablets whole, the 90 mg tablet can be crushed to a fine powder and mixed in ½ glass of water. Consume the contents of the glass immediately. Rinse the glass with another ½ glass of water and immediately drink this.

If you are taking Brilinta (Ticagrelor), you will probably also be taking 75 mg to 150 mg of acetylsalicylic acid (ASA) daily.

It is important to take Brilinta (Ticagrelor) exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Brilinta (Ticagrelor) at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause headaches; it may cause difficulty breathing; it may cause nausea or, rarely, vomiting; it may cause nosebleeds; it may cause a cough; it may lower your blood pressure, which could cause weakness and/or dizziness. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

60 mg
Each round, biconvex, pink, film-coated tablet with "60" over "T" on one side and plain on the reverse side contains 60 mg of Brilinta (Ticagrelor). Nonmedicinal ingredients: dibasic calcium phosphate, ferric oxide black, ferric oxide re), hydroxypropyl cellulose, hypromellose, magnesium stearate, mannitol, polyethylene glycol 400, sodium starch glycolate, and titanium dioxide.

90 mg
Each round, biconvex, yellow, film-coated tablet, marked with "90" over "T" on one side and plain on the reverse side, contains 90 mg of Brilinta (Ticagrelor). Nonmedicinal ingredients: dibasic calcium phosphate, ferric oxide yellow, hydroxypropyl cellulose, hypromellose, magnesium stearate, mannitol, polyethylene glycol 400, sodium starch glycolate, talc, and titanium dioxide.

Do not take Brilinta (Ticagrelor) if you:

• are allergic to Brilinta (Ticagrelor) or any ingredients of Brilinta (Ticagrelor)
• are taking medications known as strong CYP3A4 inhibitors, such as ketoconazole, clarithromycin, ritonavir, and atazanavir
• have a history of bleeding in the brain
• have moderately to severely reduced liver function
• have problems with bleeding (e.g., stomach or intestinal ulcer, bleeding in the brain)

There may be an interaction between Brilinta (Ticagrelor) and any of the following:

• acetylsalicylic acid (ASA) at doses more than 150 mg daily
• Anagrelide
• Apalutamide
• Apixaban
• Aprepitant
• "azole" antifungals (e.g., itraconazole, ketoconazole, Voriconazole)
• Bismuth Subsalicylate
• Bosentan
• Carbamazepine
• Celecoxib
• Clopidogrel
• Cobicistat
• conivaptan
• Cyclosporine
• dabigatran
• Deferasirox
• Digoxin
• diltiazem
• Dipyridamole
• Dronedarone
• Edoxaban
• Elagolix
• Enzalutamide
• glucosamine
• grapefruit juice
• Heparin
• herbal products that affect bleeding (e.g., dong quai, evening primrose, feverfew, garlic, ginger, St John's wort)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, nelfinavir, ritonavir, saquinavir)
• low molecular weight heparins (LMWHs; e.g., Dalteparin, Enoxaparin, Tinzaparin)
• lumacaftor and Ivacaftor
• macrolide antibiotics (e.g., clarithromycin, erythromycin, telithromycin)
• mifepristone
• Modafinil
• multivitamins
• narcotic pain relievers (e.g., Codeine, Fentanyl, Hydrocodone, Morphine, Oxycodone)
• nonsteroidal anti-inflammatory medication- NSAIDs (e.g., Ibuprofen, Ketoprofen, Naproxen)
• Obinutuzumab
• omega-3-fatty acids
• Pentoxifylline
• Phenobarbital
• Phenytoin
• Prasugrel
• primidone
• protein kinase inhibitors (e.g., Crizotinib, Dasatinib, imatinib, Nilotinib)
• rifabutin
• rifampin
• Rivaroxaban
• St. John's wort
• Sarilumab
• selective serotonin reuptake inhibitors (SSRIs; e.g., Fluoxetine, Fluvoxamine, Sertraline)
• serotonin-norepinephrine reuptake inhibitors (SNRIs; Desvenlafaxine, Duloxetine, Venlafaxine)
• siltuximab
• "statin" anti-cholesterol medications (e.g., Atorvastatin, Lovastatin, Simvastatin)
• Ticlopidine
• Tocilizumab
• Tranexamic acid
• verapamil
• Vilazodone
• vitamin E
• Warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Brilinta (Ticagrelor). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Brilinta (Ticagrelor).

ASA dose: Brilinta (Ticagrelor) is usually used along with low doses of acetylsalicylic acid (ASA) unless there is a reason you should not take ASA. The dose of ASA should not be greater than 150 mg daily.

Bleeding: Brilinta (Ticagrelor) can increase your risk of bleeding. If you are at risk of bleeding (e.g., have had recent trauma, surgery, dental procedures, bleeding in the stomach or intestines, reduced liver function) or are taking any medications that increase your risk of bleeding (e.g., blood thinners, nonsteroidal anti-inflammatory medication), discuss with your doctor how Brilinta (Ticagrelor) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Brilinta (Ticagrelor), and whether any special monitoring is needed.

Tell your doctor of any signs that your blood is not clotting as quickly as usual. Such symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding.

Breathing problems: Brilinta (Ticagrelor) can cause shortness of breath for some people. It is usually mild to moderate and typically gets better as your body adjusts to the medication. If you have Asthma or COPD (Chronic Obstructive Pulmonary Disease), discuss with your doctor how Brilinta (Ticagrelor) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Brilinta (Ticagrelor), and whether any special monitoring is needed.

Dizziness/reduced alertness: Brilinta (Ticagrelor) may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how Brilinta (Ticagrelor) affects you.

Grapefruit juice: Grapefruit juice affects how Brilinta (Ticagrelor) is removed from the body and may cause too much of the medication to build up in the body, possibly causing harmful side effects. Do not drink grapefruit juice or eat grapefruit at any time while taking Brilinta (Ticagrelor).

Heart rhythm: Brilinta (Ticagrelor) may cause changes in heart rhythm. If you have certain abnormal heart rhythms (e.g., sick sinus syndrome, 2nd- or 3rd-degree heart block, or fainting because of a slow heartbeat, and do not have a pacemaker) or are taking medication that slows the heart rate (e.g., Atenolol, Diltiazem, Verapamil, Metoprolol), discuss with your doctor how Brilinta (Ticagrelor) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Brilinta (Ticagrelor), and whether any special monitoring is needed.

High uric acid levels and gout: Brilinta (Ticagrelor) may cause an increase in the amount of uric acid in the blood. If you have or have had high uric acid blood levels or gout, discuss with your doctor how Brilinta (Ticagrelor) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Brilinta (Ticagrelor), and whether any special monitoring is needed.

If you develop painful, warm, and swollen joints or difficulty with urination, contact your doctor as soon as possible.

Kidney function: If you are receiving dialysis, discuss with your doctor how Brilinta (Ticagrelor) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Brilinta (Ticagrelor), and whether any special monitoring is needed.

Liver function: Brilinta (Ticagrelor) is broken down by the liver so it can be removed from the body. Liver disease or reduced liver function may cause a build-up of Brilinta (Ticagrelor) in the body and cause side effects. If you have liver disease or decreased liver function, discuss with your doctor how Brilinta (Ticagrelor) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Brilinta (Ticagrelor), and whether any special monitoring is needed.

If you have moderately to severely reduced liver function, you should not take Brilinta (Ticagrelor).

Stopping medication: If you stop Brilinta (Ticagrelor), you will be at an increased risk of having a stroke or heart attack. If your doctor suggests stopping Brilinta (Ticagrelor) temporarily because of side effects, it should be restarted as soon as the risk of the side effect is less than the risk of not taking the medication.

Surgery: If you have elective (planned) surgery, your doctor will tell you when to stop taking Brilinta (Ticagrelor) before the surgery.

Pregnancy: The safety of using Brilinta (Ticagrelor) during pregnancy has not been established. If you could become pregnant while taking Brilinta (Ticagrelor), use appropriate birth control to prevent pregnancy.

Brilinta (Ticagrelor) should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Brilinta (Ticagrelor), contact your doctor immediately.

Breast-feeding: It is not known if Brilinta (Ticagrelor) passes into breast milk. If you are breast-feeding and are taking Brilinta (Ticagrelor), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Brilinta (Ticagrelor) have not been established for children and adolescents less than 18 years of age.

This medication is typically used twice a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. This medication may be taken with or without food. Avoid grapefruit and grapefruit juice during your treatment. Grapefruit can seriously affect how this medication works.