Ticagrelor

What is ticagrelor?

Ticagrelor is a prescription-only antiplatelet medicine used to prevent blood clots. It is sold under the brand name Brilique. Ticagrelor works by stopping platelets, which are a type of blood cell, from sticking together and forming clots that can block blood vessels and cause heart attacks or strokes[1]. 

What is ticagrelor used for?

Ticagrelor is primarily used to prevent blood clots in people who have had a heart attack, unstable angina, or acute coronary syndrome (ACS). It’s also used to reduce the risk of stroke, another heart attack, or death from cardiovascular causes. It is often prescribed alongside low-dose aspirin to enhance its antiplatelet effect[1]. 

How does ticagrelor work?

Ticagrelor blocks a receptor on platelets called P2Y12, which is involved in platelet activation. By inhibiting this receptor, ticagrelor reduces platelet aggregation, lowering the risk of clot formation in arteries[1]. 

Who can take ticagrelor?

Ticagrelor can be taken by[1]: 

• Adults with a history of ACS or heart attack 

• Those at high risk of cardiovascular events 

You should speak to a doctor or pharmacist first if you[1]: 

• Have a history of bleeding in the brain (haemorrhage or stroke) 

• Have severe liver disease 

• Have ever had a stomach ulcer 

• Have recently had surgery 

• Have breathing difficulties, like COPD or asthma 

• Have an abnormal heart rate 

• Have gout or high uric acid levels in your body 

• People allergic to ticagrelor or any of its ingredients 

• Those taking certain medicines like ketoconazole, clarithromycin, nefazodone, or ritonavir 

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2].  

What is the typical dosage of ticagrelor?

Ticagrelor tablets come in strengths of 60mg or 90mg and in a standard or orodispersible form. The usual dose is[1]: 

• After a heart attack - 180mg as a single dose on your first day of treatment, then 90mg twice daily for up to 12 months, which then may be switched to 60mg twice daily for long-term prevention 

• For unstable angina - 180mg as a single dose on your first day of treatment, then 90mg twice daily for up to 12 months 

• After a minor or mini stroke - 180mg as a single dose on your first day of treatment, then 90mg twice daily combined with aspirin for the first 30 days (unlicensed indication) 

Always follow your pharmacist or doctor’s instructions regarding dosage. 

How do you take ticagrelor?

For standard tablets, swallow them whole with a drink of water, but you can crush them and mix with water if you’re having trouble swallowing them. For the melt-in-your-mouth (orodispersible) form, put the tablet on your tongue and let it dissolve. You can then wash it down with water[1]. 

Can you stop taking ticagrelor?

You should not stop taking ticagrelor without consulting your pharmacist or doctor. Stopping suddenly can increase your risk of a heart attack or stroke[1]. 

What do you do if you take too much ticagrelor?

If you take more than prescribed, contact your doctor or go to A&E immediately. You may be at increased risk of bleeding[1]. 

What do you do if you forget to take ticagrelor

If you miss a dose, take it as soon as you remember. If it’s nearly time for your next dose, skip the missed dose – do not take two doses at once[1]. 

What medicines can’t you take with ticagrelor?

Tell your doctor if you're taking any other medicines or supplements, including[1]: 

• Blood thinners (e.g., warfarin, heparin, low-dose aspirin, rivaroxaban, apixaban, edoxaban, dabigatran, dipyridamole, clopidogrel, or prasugrel) 

• NSAIDs (e.g., ibuprofen), which may increase bleeding risk 

• Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) 

• Antidepressants called SSRIs  

• Antibiotics (clarithromycin, rifampicin) 

• Epilepsy medication (phenytoin, carbamazepine) 

• Digoxin, as ticagrelor may increase its levels 

• Statins – monitor for muscle problems 

• HIV medication (ritonavir, daurnavir, atazanavir) 

• Ciclosporin 

• Morphine 

• Grapefruit juice 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2]. 

What are the side effects of ticagrelor?

Common side effects include[1]: 

• Shortness of breath 

• Bleeding (nosebleeds, bruising, gastrointestinal bleeding) 

• Headache 

• Abdominal pain 

• Fatigue. 

• Dizziness 

• Nausea, constipation, or diarrhoea 

• Indigestion 

• Mild rash 

Serious side effects include[1]: 

• Severe bleeding 

• Slow heart rate 

• Signs of a brain bleed (e.g., sudden weakness on one side, severe headache, confusion). 

• Increased uric acid levels (may trigger gout) 

Seek urgent medical attention for severe bleeding or signs of a brain bleed.  

You should contact your GP if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include[1]:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2]. 

Frequently asked questions about ticagrelor

How does ticagrelor differ from aspirin? 
It works on a different platelet receptor and is often used with aspirin[1]. 

Can I drink alcohol while taking ticagrelor? 
Moderate alcohol may be okay, but it can increase the risk of a stomach ulcer – check with your doctor or pharmacist[1]. 

Can I take ticagrelor long-term? 
Yes,  Some patients may continue ticagrelor at a lower dose (60 mg twice daily) after 12 months if advised by a doctor. [1]. 

Can I take herbal supplements with ticagrelor? 
Some may interact – always check with your pharmacist or doctor[1]. 

Does ticagrelor cause breathlessness? 
Yes, this is a known side effect for some people[1]. 

Is there any food or drink I need to avoid? 
Avoid drinking grapefruit juice, as it can amplify the medicine’s effects and make you bleed more[1]. 

For the official NHS guide to ticagrelor, visit their website.