Ticagrelor (Brilinta) is a selective, reversible P2Y12 receptor antagonist belonging to the class of novel antiplatelet agents. By blocking ADP-mediated platelet activation, this medication effectively prevents arterial thrombosis and is primarily indicated for patients with acute coronary syndrome (ACS) and old myocardial infarction.

How to Use Ticagrelor (Brilinta)

Acute Coronary Syndrome (Including Unstable Angina, Non-ST-Segment Elevation Myocardial Infarction [NSTEMI], ST-Segment Elevation Myocardial Infarction [STEMI])

For adults: The initial loading dose is 180 mg (i.e., 2 tablets of the 90 mg strength), followed by a maintenance dose of 90 mg orally twice daily.

Must be used in combination with aspirin (81–100 mg daily).

Old Myocardial Infarction

Indicated for patients with at least one high-risk factor: age ≥ 65 years, diabetes mellitus requiring pharmacotherapy, history of multiple myocardial infarctions, multi-vessel coronary artery disease, or chronic non-end-stage renal insufficiency.

For adults: The usual dose is 60 mg orally twice daily, also to be used in combination with aspirin.

Administration Precautions

There is no strict restriction on taking the medication before or after meals, but it is recommended to take it at a fixed time to ensure adherence.

If a dose is missed, take the next scheduled dose as usual; do not double the dose to make up for the missed one.

Dosage Adjustment of Ticagrelor (Brilinta)

Patients with Hepatic Impairment

Contraindicated in patients with moderate or severe hepatic impairment (Child-Pugh Class B or C).

Patients with mild hepatic impairment require close monitoring for adverse reactions.

Drug Interactions

Concomitant use with strong CYP3A4 inhibitors (e.g., itraconazole, clarithromycin) or inducers (e.g., rifampicin, carbamazepine) is prohibited.

If concomitant use with moderate CYP3A4 inhibitors (e.g., diltiazem) is unavoidable, dosage reduction and enhanced monitoring should be considered.

Administration in Special Populations for Ticagrelor (Brilinta)

Patients with Hepatic Impairment

Mild Impairment (Child-Pugh Class A): Use with caution and monitoring.

Moderate to Severe Impairment (Child-Pugh Class B/C): Absolutely contraindicated.

Pregnant Women, Lactating Women, and Children

Pregnant Women: Use only if the potential therapeutic benefit is clearly established and the risks are manageable (animal studies indicate a risk of embryonic developmental abnormalities).

Lactating Women: Breastfeeding is recommended to be discontinued (the drug can be excreted in breast milk).

Children: Efficacy data are insufficient; use is prohibited.

Other High-Risk Populations

Patients with Bleeding Tendency (e.g., recent surgery, hemophilia): Contraindicated.

Patients with a History of Cerebral Hemorrhage or Active Bleeding: Absolutely contraindicated.

Patients with Chronic Respiratory Diseases (e.g., COPD, asthma): Use with caution, as it may induce dyspnea.

Patients Taking β-Blockers: May increase the risk of bradycardia.