Indications for BRILINTA:
To reduce the rate of cardiovascular death, MI, and stroke in patients with acute coronary syndrome (ACS) or history of MI. To reduce the rate of stent thrombosis in patients who have been stented for ACS.
Swallow whole; if unable to swallow, may crush tabs, then mix with water and drink or give via NG tube (CH8 or greater). Initially 180mg loading dose, continue with 90mg twice daily during the first year; after one year, give 60mg twice daily. After the initial loading dose of aspirin, take ticagrelor with maintenance dose of aspirin 75–100mg daily.
History of intracranial hemorrhage. Active pathological bleeding (eg, peptic ulcer, intracranial hemorrhage).
Bleeding risk. Aspirin dose and Brilinta effectiveness.
Increased risk of bleeding. Do not start in patients planned to undergo urgent CABG. Premature discontinuation increases risk for CV events (eg, MI, stroke, death). Avoid interruption of treatment; if temporarily discontinued, restart as soon as possible. When possible, interrupt therapy for 5 days prior to surgery (those with major bleeding risk); resume upon hemostasis. History of sick sinus syndrome, 2nd or 3rd-degree AV block or bradycardia-related syncope without a pacemaker: increased risk of bradyarrhythmias. Moderate hepatic impairment. Severe hepatic impairment: avoid. Pregnancy. Nursing mothers: not recommended.
P2Y12 platelet inhibitor (cyclopentyltriazolopyrimidine).
Effectiveness reduced with aspirin maintenance dose >100mg; avoid. Concomitant other oral P2Y12 platelet inhibitor: not recommended. Avoid concomitant strong CYP3A inhibitors (eg, ketoconazole, itraconazole, voriconazole, clarithromycin, nefazodone, ritonavir, saquinavir, nelfinavir, indinavir, atazanavir, telithromycin) or potent CYP3A inducers (eg, rifampin, phenytoin, carbamazepine, phenobarbital). Antagonized by opioid agonists (eg, morphine, others); consider using IV anti-platelet agent instead. Potentiates simvastatin, lovastatin; avoid >40mg/day doses. Monitor digoxin during ticagrelor initiation and dose adjustments. May cause false negative platelet function tests for HIT.
Bleeding (may be fatal), dyspnea (consider other alternatives if intolerable), dizziness, nausea, diarrhea; ventricular pauses.