Indications for BRILINTA:
To reduce the risk of cardiovascular death, MI, and stroke in patients with acute coronary syndrome (ACS) or history of MI. To reduce the risk of stent thrombosis in patients who have been stented for ACS. To reduce the risk of a first MI or stroke in patients with coronary artery disease (CAD) at high risk for such events. To reduce the risk of stroke in patients with acute ischemic stroke (NIH Stroke Scale score ≤5) or high-risk transient ischemic attack (TIA).
Swallow whole; if unable to swallow, may crush tabs, then mix with water and drink or give via NG tube (CH8 or greater). ACS or history of MI: initially 180mg loading dose, continue with 90mg twice daily during the first year; after one year, give 60mg twice daily. CAD (no prior stroke or MI): 60mg twice daily. ACS, history of MI, or CAD: use with maintenance dose of aspirin 75–100mg daily. Acute ischemic stroke or TIA: initially 180mg loading dose, continue with 90mg twice daily for up to 30 days; use with a loading dose of aspirin (300–325mg), then 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 undergoing urgent CABG. For acute ischemic stroke or TIA: not recommended if NIHSS >5 or receiving thrombolysis. Discontinuation increases risk for CV events (eg, MI, stroke, death) in those treated for CAD. 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).
For ACS: 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.
Generic Drug Availability: