Ticagrelor

Sounds like ('tie-kag-re-lore')

Easy-to-read medicine information about ticagrelor – what it is, how to take it safely and possible side effects.

Type of medicine Also called
  • Blood-thinning medication 
  • Belongs to a group of medicines that prevent blood clots, known as anti-platelets
  • Brilinta®

What is ticagrelor?

Ticagrelor is an anti-platelet medication or blood thinner. It is usually used in people who have symptoms of chest pain (angina) or who have had a heart attack (myocardial infarction) to reduce the risk of having a further heart attack or stroke. It blocks certain blood cells called platelets and slows down your body’s ability to clot blood. It is used to prevent blood clots forming in blood vessels that lead to your brain and heart muscle. Preventing blood clots in these vessels helps lower your risk of stroke and heart attack. In New Zealand ticagrelor is available as 60 and 90 milligram tablets.

Dose

  • The usual dose of ticagrelor is 90 milligrams two times a day. You may be given a starting dose of 2 tablets the first time you take it.
  • Ticagrelor is usually taken together with low-dose aspirin for up to 12 months.
  • Some people may need to take it for more than 12 months, at a lower dose of 60 milligrams two times daily. 
  • Always take your ticagrelor exactly as your doctor has told you. The pharmacy label will tell you how much ticagrelor to take, how often to take it and any special instructions.  

How to take ticagrelor

  • Swallow your tablets with a glass of water.
  • If you can't swallow the tablet, you can crush it and mix it with half a glass of water, just before taking it. To make sure that there is no medicine left, rinse the empty glass with another half a glass of water and drink it.
  • You can take ticagrelor with or without food.
  • Take your ticagrelor doses at the same times each day, in the morning and the evening. 
  • If you forget to take your dose, take it as soon as possible except when it is close to the time for your next dose. If it is almost time for next dose, skip the missed dose and return to your regular dosing schedule. You should not take two doses at the same time.
  • It is important to let health professionals know that you are taking ticagrelor, such as your dentist, pharmacist or nurse. You may need to stop using this medicine for several days before having surgery.

Precautions – before starting ticagrelor

  • Do you have stomach problems such as an ulcer?
  • Have you had surgery within the past 30 days?
  • Do you have any problems with your heart, such as an abnormal heart rate?
  • Do you have a problems with your breathing such as asthma or COPD?
  • Have you ever had a stroke caused by bleeding in your brain (called intracranial haemorrhage)?
  • Do have any problems with your liver?
  • Do you have high blood levels of uric acid or gout?
  • Are you pregnant or breastfeeding?
  • Are you taking any other medicines? This includes any medicines you buy without a prescription, such as herbal and complementary medicines.

If so, it’s important that you tell your doctor or pharmacist before you start ticagrelor. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Possible side effects

Like all medicines, ticagrelor can cause side effects, although not everyone gets them. Common side effects include nausea (feeling sick), shortness of breath, feeling dizzy or light headed and diarrhoea (runny poos). These usually go away with time. Tell your doctor if troublesome.

Increased risk of gout

Ticagrelor can increase the level of uric acid in your blood and cause a flare up of gout. Tell your doctor if you get severe pain and swelling in your joints – these are signs of gout.

Increased risk of bleeding

Ticagrelor increases your risk of bleeding. You might bleed or bruise more easily while you are taking ticagrelor. Minor bleeding such as a nosebleed should usually stop on its own. If you have a fall or hurt your head or body, get medical attention immediately, even if you feel okay.

Signs of severe bleeding

If you have any of the following signs of bleeding, contact your doctor immediately or ring Healthline for free 24-hour health advice 0800 611 116:
  • becoming pale, very weak and tired, or short of breath
  • any bleeding from your gums or cuts or nosebleeds that won’t stop
  • blood in your stools (poo) – black, tarry stools
  • blood in your urine (wee) – pink, red or brown-coloured urine
  • coughing up blood or vomit that looks like coffee grounds
  • sudden numbness or weakness of your arm, leg or face, especially if only on one side of your body
  • sudden confusion, difficulty speaking or understanding others
  • sudden difficulty in walking or loss of balance or co-ordination
  • suddenly feeling dizzy or sudden severe headache with no known cause. 

Interactions

Ticagrelor should not be taken with some other medications and herbal supplements, so always check with your doctor or pharmacist before starting ticagrelor or before starting any new medicines. Also check with your pharmacist before taking:

  • over-the-counter anti-inflammatories such as diclofenac (eg, Voltaren Rapid), ibuprofen (eg, Nurofen), naproxen (eg, Naprogesic)
  • herbal extracts such as garlic, ginkgo or ginseng.

Taking these together with ticagrelor may increase your risk of bleeding and should be avoided. 

Learn more

The following links provide further information on ticagrelor. 

Ticagrelor New Zealand Formulary Patient Information
Brilinta® Medsafe Consumer Information Sheet (NZ)

References

  1. Ticagrelor – out with the old, in with the new? BPAC, NZ, 2013
  2. An update on antithrombotic medicines - what does primary care need to know? BPAC, NZ, 2015
  3. Ticagrelor New Zealand Formulary
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 19 Aug 2018