Brilique (Ticagrelor): Uses, Dosage & Side Effects
Antiplatelet medication to prevent blood clots after heart attack
Quick facts about Brilique
Key takeaways about Brilique
- Reversible P2Y12 inhibitor: Unlike clopidogrel, ticagrelor binds reversibly to platelets and does not need liver activation, providing faster onset and more consistent antiplatelet effect
- Always taken with aspirin: Brilique 60 mg must be taken with low-dose aspirin (75–150 mg daily), but aspirin doses above 100 mg may reduce its effectiveness
- Twice-daily dosing: Take one 60 mg tablet in the morning and one in the evening at approximately the same times each day for optimal protection
- Dyspnoea is common: Shortness of breath occurs in up to 14% of patients and is usually mild and self-limiting – it does not indicate worsening heart or lung disease
- Do not stop abruptly: Stopping Brilique without medical advice significantly increases the risk of another heart attack, stroke, or cardiovascular death
What Is Brilique and What Is It Used For?
Brilique (ticagrelor) is a direct-acting, reversible antiplatelet medication that prevents blood clots by blocking the P2Y12 ADP receptor on platelets. The 60 mg formulation is prescribed for adults who have had a heart attack more than one year ago, in combination with low-dose aspirin, to reduce the risk of further heart attack, stroke, or death from cardiovascular disease.
Brilique contains the active substance ticagrelor, which belongs to a group of medicines called antiplatelet agents (specifically, P2Y12 receptor antagonists). These medicines prevent the formation of dangerous blood clots by stopping platelets – small blood cells involved in clotting – from clumping together. By keeping blood flowing more freely through the arteries, Brilique reduces the risk of serious cardiovascular events.
Ticagrelor belongs to the cyclopentyltriazolopyrimidine (CPTP) chemical class, making it structurally distinct from the thienopyridine drugs clopidogrel and prasugrel. A critical pharmacological difference is that ticagrelor is a direct-acting, reversible P2Y12 antagonist. Unlike clopidogrel, which is a prodrug requiring hepatic activation by CYP2C19, ticagrelor does not need metabolic conversion to exert its antiplatelet effect. This means its activity is not affected by genetic polymorphisms in liver enzymes – a significant advantage, as up to 30% of certain populations carry reduced-function CYP2C19 alleles that diminish clopidogrel effectiveness.
Because ticagrelor binds reversibly to the P2Y12 receptor, platelet function recovers more quickly after discontinuation (typically within 3–5 days) compared to irreversible inhibitors like clopidogrel (5–7 days). The drug also has an active metabolite, AR-C124910XX, which contributes approximately equally to the overall antiplatelet effect. Steady-state plasma concentrations are achieved within 2–3 days of twice-daily dosing, with near-complete platelet inhibition occurring within 2 hours of the first dose.
How platelets form blood clots
Platelets are very small blood cells that play a crucial role in stopping bleeding. When a blood vessel is damaged, platelets aggregate (clump together) at the site of injury to form a plug that seals the wound. This is a normal, life-saving process. However, in patients with atherosclerosis – a condition where fatty deposits (plaques) build up inside artery walls – platelets can become activated at the site of a damaged or ruptured plaque, forming a blood clot (thrombus) inside the artery.
Such a clot can have devastating consequences. If it completely blocks blood flow in a coronary artery, it causes a heart attack (myocardial infarction). If it blocks blood flow in an artery supplying the brain, it causes an ischaemic stroke. Partial blockage can reduce blood flow sufficiently to cause chest pain that comes and goes (unstable angina). Brilique prevents platelets from clumping together at these dangerous sites, thereby reducing the risk of clot formation and subsequent cardiovascular events.
Approved indication for Brilique 60 mg
Brilique 60 mg is specifically approved for long-term secondary prevention in adults who have had a myocardial infarction (heart attack) at least 12 months ago and who are at high risk of developing another atherothrombotic event. It is always prescribed in combination with low-dose acetylsalicylic acid (aspirin), typically 75–150 mg daily. This dual antiplatelet therapy provides broader and more effective platelet inhibition than either agent alone.
Ticagrelor is available in two strengths: 90 mg and 60 mg. The 90 mg formulation is used during the acute phase and the first 12 months after an acute coronary syndrome (heart attack or unstable angina). After 12 months, patients who remain at high cardiovascular risk may be switched to the 60 mg formulation for extended secondary prevention. The 60 mg dose was specifically studied in the PEGASUS-TIMI 54 trial, which demonstrated a significant reduction in the composite endpoint of cardiovascular death, heart attack, or stroke compared with aspirin alone.
What Should You Know Before Taking Brilique?
Before starting Brilique, your doctor must evaluate your bleeding risk, current medications, and overall health. Brilique is contraindicated in patients with active bleeding, history of intracranial haemorrhage, severe liver disease, or those taking strong CYP3A4 inhibitors such as ketoconazole, clarithromycin, or ritonavir.
Like all antiplatelet medications, Brilique increases the risk of bleeding. It is essential that you provide your doctor with a complete medical history and a list of all medicines you are currently taking before starting treatment. Some conditions and medications can significantly increase the risk of dangerous bleeding or may interact with ticagrelor in ways that alter its safety or effectiveness.
Contraindications
You must not take Brilique if any of the following apply:
- Allergy to ticagrelor: If you are allergic to ticagrelor or any of the other ingredients in Brilique tablets
- Active bleeding: If you currently have any active bleeding, including internal bleeding
- History of intracranial haemorrhage: If you have ever had a stroke caused by bleeding in the brain (haemorrhagic stroke)
- Severe liver disease: If you have severe hepatic impairment, as ticagrelor is extensively metabolised by the liver
- Strong CYP3A4 inhibitors: If you are currently taking any of the following medications: ketoconazole (antifungal), clarithromycin (antibiotic), nefazodone (antidepressant), ritonavir or atazanavir (HIV protease inhibitors). These drugs dramatically increase ticagrelor blood levels, raising the risk of bleeding and other adverse effects
Warnings and precautions
Talk to your doctor or pharmacist before taking Brilique if any of the following apply to you:
- Increased bleeding risk: If you have recently had a serious injury, recent surgery (including dental procedures), a condition affecting blood clotting, or recent gastrointestinal bleeding (such as a stomach ulcer or colon polyps)
- Upcoming surgery: If you are scheduled for any surgery, including dental procedures, while taking Brilique. Your doctor may advise you to stop taking ticagrelor 5 days before the procedure to reduce surgical bleeding risk
- Slow heart rate (bradycardia): If your resting heart rate is abnormally low (usually below 60 beats per minute) and you do not have a pacemaker. Ticagrelor can cause ventricular pauses and may worsen pre-existing bradycardia
- Asthma or lung problems: If you have asthma, chronic obstructive pulmonary disease (COPD), or other breathing difficulties. Ticagrelor commonly causes dyspnoea (shortness of breath), which may be more noticeable in patients with pre-existing respiratory conditions
- Abnormal breathing patterns: If you develop changes in your breathing rhythm, including faster, slower, or intermittent breathing. Your doctor may recommend further investigation, such as sleep studies, to rule out central sleep apnoea
- Liver problems: If you have a history of liver disease or any condition that may have affected your liver function. Although mild to moderate hepatic impairment does not require dose adjustment, liver function should be monitored
- Elevated uric acid: If blood tests have shown higher-than-normal levels of uric acid in your blood, as ticagrelor may further increase uric acid levels and potentially trigger gout in susceptible individuals
If you are taking both Brilique and heparin, and your doctor suspects heparin-induced thrombocytopenia (HIT), it is important to inform them that you are taking ticagrelor. Brilique may interfere with the functional diagnostic assays used to detect HIT, potentially producing false-negative results. Your doctor may need to use alternative testing methods.
Pregnancy and breastfeeding
Brilique is not recommended during pregnancy or in women who could become pregnant unless effective contraception is used. There is insufficient human data on the safety of ticagrelor during pregnancy, and animal studies have shown reproductive toxicity. If you are pregnant, think you may be pregnant, or are planning to become pregnant, consult your doctor before taking this medicine.
It is not known whether ticagrelor or its metabolites are excreted in human breast milk, although animal studies have shown excretion in milk. Your doctor will discuss the potential benefits and risks of taking Brilique while breastfeeding. A decision must be made whether to discontinue breastfeeding or discontinue the drug, taking into account the importance of the medicine to the mother and the potential risk to the infant.
Driving and operating machinery
Brilique is unlikely to affect your ability to drive or use machines. However, if you experience dizziness or confusion while taking this medication, you should exercise caution when driving or operating machinery until the symptoms resolve.
Children and adolescents
Brilique is not recommended for use in children and adolescents under 18 years of age, as there is insufficient evidence regarding safety and efficacy in this age group.
How Does Brilique Interact with Other Drugs?
Brilique has clinically significant interactions with strong CYP3A4 inhibitors and inducers, certain statins, digoxin, cyclosporine, and opioid analgesics. Aspirin doses above 100 mg daily may reduce ticagrelor's effectiveness. Always inform your doctor and pharmacist about all medicines you are taking.
Ticagrelor is primarily metabolised by the liver enzyme CYP3A4 and also acts as an inhibitor of CYP3A4 and P-glycoprotein (P-gp). This means it can both be affected by and affect the blood levels of many other medications. Understanding these interactions is crucial for safe and effective treatment.
Major interactions – contraindicated combinations
The following medications must not be used together with Brilique, as they dramatically increase ticagrelor plasma levels and the risk of serious bleeding:
| Drug | Class | Mechanism | Clinical Effect |
|---|---|---|---|
| Ketoconazole | Antifungal | Strong CYP3A4 inhibitor | Increases ticagrelor levels by ~7-fold |
| Clarithromycin | Macrolide antibiotic | Strong CYP3A4 inhibitor | Markedly increases ticagrelor exposure |
| Nefazodone | Antidepressant | Strong CYP3A4 inhibitor | Significantly elevates ticagrelor levels |
| Ritonavir | HIV protease inhibitor | Strong CYP3A4 inhibitor | Major increase in ticagrelor exposure |
| Atazanavir | HIV protease inhibitor | Strong CYP3A4 inhibitor | Major increase in ticagrelor exposure |
Significant interactions – use with caution
The following medications may interact with Brilique and require monitoring or dose adjustments:
| Drug | Effect | Recommendation |
|---|---|---|
| Simvastatin / Lovastatin | Ticagrelor increases statin levels (simvastatin by ~56%); doses above 40 mg/day increase risk of myopathy | Do not exceed 40 mg/day of simvastatin or lovastatin |
| Rosuvastatin | Ticagrelor may increase rosuvastatin exposure | Monitor for statin side effects; consider lower starting dose |
| Digoxin | Ticagrelor inhibits P-gp, increasing digoxin levels by ~28% | Monitor digoxin levels; watch for toxicity symptoms |
| Cyclosporine | Dual P-gp and CYP3A4 inhibition; may increase both drug levels | Monitor cyclosporine levels closely |
| Rifampicin | Strong CYP3A4 inducer; reduces ticagrelor levels by ~86% | Combination is discouraged; may eliminate antiplatelet effect |
| Phenytoin / Carbamazepine / Phenobarbital | CYP3A4 inducers; significantly reduce ticagrelor exposure | Combination is discouraged |
| Morphine / Opioids | Opioids delay gastric emptying, slowing ticagrelor absorption by ~36% | Consider IV P2Y12 inhibitor (cangrelor) in acute settings when opioids are co-administered |
| Diltiazem / Verapamil | Moderate CYP3A4 inhibitors; may increase ticagrelor levels | Monitor for increased bleeding; no dose adjustment usually needed |
| Beta-blockers | Additive bradycardic effect | Monitor heart rate, especially in patients with pre-existing bradycardia |
Bleeding risk interactions
The following medications increase the risk of bleeding when taken with Brilique, and particular caution is warranted:
- Oral anticoagulants (warfarin, DOACs): Concurrent use with blood thinners such as warfarin, rivaroxaban, apixaban, edoxaban, or dabigatran significantly increases the risk of major bleeding. If combination therapy is necessary, it should only be prescribed under specialist supervision with careful monitoring
- NSAIDs (ibuprofen, naproxen, diclofenac): Non-steroidal anti-inflammatory drugs increase the risk of gastrointestinal bleeding. Use the lowest effective dose for the shortest duration possible, and consider gastroprotective therapy
- SSRIs (paroxetine, sertraline, citalopram): Selective serotonin reuptake inhibitor antidepressants impair platelet function and may increase bleeding risk when combined with antiplatelet agents
- Fibrinolytic agents (streptokinase, alteplase): If you need clot-dissolving therapy, inform medical staff that you are taking Brilique, as the combination substantially increases bleeding risk
The PLATO trial found that aspirin doses above 100 mg daily were associated with reduced effectiveness of ticagrelor compared with lower doses. Current guidelines recommend that the maintenance aspirin dose should not exceed 100 mg daily when used in combination with ticagrelor. Most guidelines suggest 75–100 mg daily for optimal benefit.
What Is the Correct Dosage of Brilique?
The recommended dose of Brilique for long-term secondary prevention is one 60 mg tablet taken twice daily (morning and evening) in combination with low-dose aspirin (75–150 mg once daily). Tablets can be taken with or without food and should be swallowed whole or crushed and mixed with water if swallowing is difficult.
Always take Brilique exactly as your doctor has prescribed. Do not change the dose or stop taking the medication without consulting your physician first. Consistency in timing is important for maintaining stable antiplatelet protection throughout the day.
Adults
Standard dosing regimen
Brilique 60 mg: One tablet twice daily (total daily dose: 120 mg)
Plus aspirin: 75–150 mg once daily (aspirin dose should not exceed 100 mg for optimal ticagrelor effectiveness)
Timing: Take one tablet in the morning and one in the evening, at approximately the same times each day
With food: Brilique can be taken with or without food
The Brilique 60 mg blister pack includes sun (morning) and moon (evening) symbols to help you track whether you have taken your dose. This is particularly helpful for maintaining adherence to the twice-daily regimen.
Difficulty swallowing
If you have difficulty swallowing tablets, Brilique can be administered as follows:
- Crush the tablet into a fine powder
- Mix the powder with half a glass of water
- Stir the mixture and drink it immediately
- Rinse the empty glass with another half glass of water and drink the rinse to ensure you receive the full dose
For hospitalised patients, crushed Brilique tablets mixed with water can also be administered via a nasogastric tube directly into the stomach.
Children and adolescents
Brilique is not recommended for children and adolescents under 18 years of age. There are no adequate data on the safety and efficacy of ticagrelor in paediatric populations.
Elderly patients
No dose adjustment is required for elderly patients. Ticagrelor has been studied in patients up to and beyond 75 years of age, and the PEGASUS-TIMI 54 trial included a substantial proportion of elderly participants. However, elderly patients may have an increased risk of bleeding and should be monitored accordingly.
Renal impairment
No dose adjustment is necessary for patients with kidney disease, including those on dialysis. However, since there is limited clinical experience with ticagrelor in patients on dialysis, caution is advised in this population.
Hepatic impairment
No dose adjustment is needed for patients with mild to moderate liver disease. Brilique is contraindicated in patients with severe hepatic impairment, as ticagrelor is extensively metabolised in the liver and severe impairment would result in significantly elevated drug levels.
Missed dose
If you forget to take a dose of Brilique, simply take your next dose at the regular scheduled time. Do not take a double dose to make up for a missed one. Maintaining a regular dosing schedule is important, so consider setting reminders or using the sun/moon symbols on the blister pack to track your doses.
Overdose
If you take more Brilique than prescribed, contact your doctor or go to the nearest hospital emergency department immediately. Bring the medicine packaging with you. An overdose may increase the risk of bleeding. There is no specific antidote for ticagrelor, and the drug is unlikely to be removed by dialysis due to its high protein binding. Treatment is symptomatic and supportive.
Stopping Brilique without consulting your doctor can significantly increase the risk of another heart attack, stroke, or death from cardiovascular disease. Take this medication regularly and for as long as your doctor continues to prescribe it. If you need to stop treatment for any reason (for example, before surgery), your doctor will plan the safest way to do so.
What Are the Side Effects of Brilique?
The most common side effects of Brilique are bleeding (bruising, nosebleeds), dyspnoea (shortness of breath), and elevated uric acid levels. Most bleeding events are mild, but serious and potentially life-threatening bleeding can occur. Dyspnoea is usually mild, occurs at rest, and often resolves within the first weeks of treatment.
Like all medicines, Brilique can cause side effects, although not everyone experiences them. Because ticagrelor affects blood clotting, most side effects are related to bleeding. Some bleeding is common and expected (such as bruising more easily or nosebleeds lasting longer). However, severe bleeding is uncommon but can be life-threatening and requires immediate medical attention.
Signs of stroke: Sudden numbness or weakness in the arm, leg, or face (especially on one side), sudden confusion, difficulty speaking or understanding, sudden difficulty walking, loss of balance, sudden dizziness, or sudden severe headache with no known cause.
Signs of serious bleeding: Severe or uncontrollable bleeding, unexpected bleeding or bleeding that lasts a long time, pink, red, or brown urine, vomiting red blood or vomit that looks like coffee grounds, red or black (tar-like) stools, coughing up blood.
Signs of TTP (thrombotic thrombocytopenic purpura): Fever, purple spots on the skin or in the mouth, with or without yellowing of the skin or eyes (jaundice), unexplained extreme tiredness or confusion.
Very Common
- Dyspnoea (shortness of breath) – usually mild, occurs at rest, may resolve within weeks
- Elevated uric acid levels in the blood (detected on blood tests)
- Bleeding due to blood disorders
Common
- Bruising (ecchymosis)
- Headache
- Dizziness or vertigo (spinning sensation)
- Diarrhoea or indigestion (dyspepsia)
- Nausea
- Constipation
- Skin rash
- Itching (pruritus)
- Severe joint pain and swelling – signs of gout (hyperuricaemia)
- Dizziness, light-headedness, or blurred vision – signs of low blood pressure
- Nosebleed (epistaxis)
- Heavier-than-normal bleeding after surgery or from wounds (e.g. while shaving)
- Gastrointestinal bleeding (stomach lining bleeding)
- Bleeding gums
- Syncope (fainting) – temporary loss of consciousness due to reduced blood flow to the brain
Uncommon
- Allergic reaction – skin rash, itching, or swelling of the face, lips, or tongue
- Confusion
- Visual disturbances due to bleeding in the eye
- Vaginal bleeding heavier than or at different times from normal menstruation
- Bleeding into joints and muscles causing painful swelling
- Bleeding from the ear
- Internal bleeding that may cause dizziness or light-headedness
Not Known
- Abnormally slow heart rate (bradycardia, usually below 60 beats per minute)
Dyspnoea (shortness of breath) explained
Dyspnoea is one of the most distinctive side effects of ticagrelor and deserves special attention. It occurs in approximately 14% of patients and is more common with the 90 mg dose than the 60 mg dose. The breathlessness associated with Brilique is typically described as a sudden, unexpected need for air. It usually occurs at rest rather than during exertion and tends to be mild in severity.
Research suggests that ticagrelor-induced dyspnoea is related to the drug's inhibition of adenosine reuptake through the equilibrative nucleoside transporter 1 (ENT1). By blocking adenosine reuptake, ticagrelor increases local adenosine concentrations, which can stimulate pulmonary C-fibres and cause a sensation of breathlessness. Importantly, this is not caused by impaired lung function or worsening heart disease.
In most patients, the dyspnoea appears within the first weeks of starting treatment and resolves spontaneously as the body adapts. If your shortness of breath becomes more severe, occurs with exertion, or is accompanied by chest pain, wheezing, or swelling, contact your doctor promptly, as these symptoms could indicate a different underlying cause that requires evaluation.
How Should You Store Brilique?
Store Brilique at room temperature with no special storage conditions required. Keep the tablets in their original blister packaging and out of the sight and reach of children. Do not use after the expiry date printed on the pack.
Brilique tablets do not require any special storage conditions. Store them at room temperature, away from excessive heat, moisture, and direct sunlight. Keep the tablets in their original blister pack until you are ready to take a dose, as this helps protect them from environmental factors that could affect their stability.
Always check the expiry date (marked “EXP”) on the blister pack and outer carton before taking a tablet. The expiry date refers to the last day of the stated month. Do not use Brilique after this date, as the medication may have degraded and could be less effective or potentially harmful.
Keep all medicines out of the sight and reach of children. Do not dispose of unused medicines via household waste or through the plumbing system. Return any unused or expired tablets to your pharmacist for safe disposal, which helps protect the environment.
What Does Brilique Contain?
Each Brilique 60 mg film-coated tablet contains 60 mg of the active substance ticagrelor. The tablets are round, biconvex, pink, and marked with “60” above “T” on one side.
The active substance in Brilique is ticagrelor. Each film-coated tablet contains 60 mg of ticagrelor.
Inactive ingredients (excipients)
The other ingredients are:
- Tablet core: Mannitol (E421), calcium hydrogen phosphate dihydrate, sodium starch glycolate type A, hydroxypropyl cellulose (E463), magnesium stearate (E470b)
- Film coating: Hypromellose (E464), titanium dioxide (E171), macrogol 400, iron oxide black (E172), iron oxide red (E172)
Appearance and packaging
Brilique 60 mg tablets are round, biconvex, pink film-coated tablets embossed with “60” above “T” on one side. They are available in:
- Standard blister packs (with sun/moon symbols): Cartons of 60 and 180 tablets
- Calendar blister packs (with sun/moon symbols): Cartons of 14, 56, and 168 tablets
Not all pack sizes may be marketed in your country. The sun and moon symbols on the blister help you remember whether you have taken your morning and evening doses.
Sodium content
Brilique contains less than 1 mmol (23 mg) sodium per tablet, meaning it is essentially sodium-free. This is relevant for patients on sodium-restricted diets.
Manufacturer
Brilique is manufactured by AstraZeneca and is available worldwide through various national marketing authorisations. It was first approved by the European Medicines Agency (EMA) in 2010 and has since been approved in over 100 countries. Generic ticagrelor products from manufacturers including Accord, Teva, Sandoz, STADA, Zentiva, SUN, and Medical Valley are also available in many markets.
Frequently Asked Questions About Brilique
Brilique (ticagrelor) 60 mg is an antiplatelet medication used in combination with low-dose aspirin to prevent further heart attacks, strokes, or death from cardiovascular disease in adults who have had a heart attack more than one year ago. It works by preventing platelets from clumping together to form dangerous blood clots inside arteries. It is always prescribed as part of dual antiplatelet therapy alongside aspirin.
Brilique (ticagrelor) is a direct-acting, reversible P2Y12 receptor antagonist, while clopidogrel is an irreversible prodrug that requires liver enzyme activation by CYP2C19. This means ticagrelor provides faster onset and offset of action, more consistent platelet inhibition regardless of genetic variations, and does not depend on liver metabolism for activation. The landmark PLATO trial showed that ticagrelor reduced the rate of cardiovascular death, heart attack, and stroke compared with clopidogrel in patients with acute coronary syndrome, though at the cost of slightly higher rates of non-procedure-related bleeding and dyspnoea.
Dyspnoea (shortness of breath) occurs in up to 14% of patients taking ticagrelor. It is believed to be related to ticagrelor's inhibition of adenosine reuptake through the equilibrative nucleoside transporter 1 (ENT1), which increases local adenosine concentrations in the lungs and stimulates sensory nerve fibres. The breathlessness is usually mild, occurs at rest rather than during exercise, and often resolves within the first few weeks of treatment. Lung function tests in affected patients show no change in respiratory function, confirming that this is a benign drug effect rather than a sign of worsening heart or lung disease.
Yes – Brilique is specifically designed to be taken together with low-dose aspirin (75–150 mg daily) as dual antiplatelet therapy (DAPT). However, it is important that the aspirin dose does not exceed 100 mg daily, as higher maintenance doses have been associated with reduced effectiveness of ticagrelor. This was an important finding from the PLATO trial. Your doctor will advise you on the correct aspirin dose to use alongside Brilique.
If you miss a dose of Brilique, simply take your next dose at the regular scheduled time. Do not take a double dose to compensate for the forgotten tablet. To help remember your doses, take one tablet in the morning and one in the evening at approximately the same times each day. The blister pack includes sun and moon symbols to help you track whether you have taken your dose. If you are worried about missed doses, speak to your doctor or pharmacist.
Brilique 60 mg is prescribed for long-term secondary prevention in patients who have had a heart attack more than one year ago. Treatment duration is determined by your doctor based on your individual cardiovascular risk profile. The PEGASUS-TIMI 54 trial demonstrated continued benefit with treatment lasting up to 3 years or longer. Never stop taking Brilique without consulting your doctor first, as abruptly discontinuing antiplatelet therapy significantly increases the risk of another heart attack, stroke, or cardiovascular death.
References
- Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes (PLATO trial). N Engl J Med. 2009;361(11):1045–1057. doi:10.1056/NEJMoa0904327
- Bonaca MP, Bhatt DL, Cohen M, et al. Long-term use of ticagrelor in patients with prior myocardial infarction (PEGASUS-TIMI 54). N Engl J Med. 2015;372(19):1791–1800. doi:10.1056/NEJMoa1500857
- European Medicines Agency (EMA). Brilique (ticagrelor) – Summary of Product Characteristics. Updated 2024. Available at: EMA – Brilique
- Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720–3826. doi:10.1093/eurheartj/ehad191
- Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease. Circulation. 2023;148(6):e149–e227.
- Joint Formulary Committee. British National Formulary (BNF). Ticagrelor. London: BMJ Group and Pharmaceutical Press; 2024.
- Storey RF, Becker RC, Harrington RA, et al. Characterization of dyspnoea in PLATO study patients treated with ticagrelor or clopidogrel and its association with clinical outcomes. Eur Heart J. 2011;32(23):2945–2953.
- Cattaneo M, Schulz R, Nylander S. Adenosine-mediated effects of ticagrelor: evidence and potential clinical relevance. J Am Coll Cardiol. 2014;63(23):2503–2509.
- World Health Organization. WHO Model List of Essential Medicines – 23rd list, 2023. Geneva: World Health Organization; 2023.
- Gurbel PA, Bliden KP, Butler K, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease. Circulation. 2009;120(25):2577–2585.
About Our Medical Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians in clinical pharmacology and cardiovascular medicine. Our team follows the GRADE evidence framework and adheres to international guidelines from the ESC, AHA/ACC, EMA, and WHO.
Medical Writing
Authored by physicians with expertise in cardiovascular pharmacology and antiplatelet therapy. All content is based on peer-reviewed clinical trials, approved product labelling, and international treatment guidelines.
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Independently reviewed by the iMedic Medical Review Board according to our editorial standards. Reviewed for clinical accuracy, evidence quality, balance, and patient comprehension.
Evidence Standards
Level 1A evidence: Based on systematic reviews and meta-analyses of randomised controlled trials, including the PLATO and PEGASUS-TIMI 54 trials. GRADE framework assessment applied.
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