Ticagrelor Vivanta (Ticagrelor): Uses, Dosage & Side Effects
Generic antiplatelet medication to prevent blood clots after heart attack
Quick facts about Ticagrelor Vivanta
Key takeaways about Ticagrelor Vivanta
- Bioequivalent generic of Brilique: Ticagrelor Vivanta contains the same active substance in the same dose and is considered therapeutically interchangeable with the reference product Brilique
- Always taken with aspirin: The 60 mg tablets must be taken with low-dose aspirin (75–100 mg daily) as dual antiplatelet therapy – higher aspirin doses may reduce ticagrelor effectiveness
- Twice-daily dosing: Take one 60 mg tablet in the morning and one in the evening at approximately the same times each day to maintain steady platelet inhibition
- Dyspnoea is common but usually benign: Shortness of breath occurs in up to 14% of patients and is typically mild, appears early in treatment and often resolves spontaneously
- Do not stop abruptly: Discontinuing Ticagrelor Vivanta without medical advice significantly increases the risk of another heart attack, stroke, or cardiovascular death
What Is Ticagrelor Vivanta and What Is It Used For?
Ticagrelor Vivanta is a generic prescription antiplatelet medicine containing 60 mg of ticagrelor per tablet. It is approved for long-term secondary prevention in adults who have had a heart attack more than one year ago and who remain at high cardiovascular risk. Taken with low-dose aspirin, it reduces the risk of further heart attack, stroke, or cardiovascular death by blocking the P2Y12 receptor on platelets and preventing harmful blood clot formation.
Ticagrelor Vivanta belongs to a class of medicines called antiplatelet agents, and more specifically to the sub-class of direct-acting P2Y12 receptor antagonists. The active ingredient, ticagrelor, prevents small blood cells known as platelets from clumping together and forming the dangerous clots (thrombi) that cause most heart attacks and ischaemic strokes. By keeping arteries open and blood flowing freely, the medicine reduces the risk of serious cardiovascular events in patients who have already experienced coronary disease.
Ticagrelor was first approved by the European Medicines Agency in 2010 under the brand name Brilique (Brilinta in the United States and some other markets), developed and marketed by AstraZeneca. Following the expiry of the original patent protection, regulatory authorities have authorised multiple generic ticagrelor products. Ticagrelor Vivanta is one of these authorised generics and has undergone formal bioequivalence testing to demonstrate that it delivers the same active drug to the bloodstream, in the same amount and at the same rate, as the originator product. In clinical terms this means patients can expect identical efficacy and the same safety profile when switching between Brilique and Ticagrelor Vivanta.
Chemically, ticagrelor belongs to the cyclopentyltriazolopyrimidine (CPTP) family, making it structurally distinct from the thienopyridine antiplatelets clopidogrel and prasugrel. Unlike clopidogrel, ticagrelor is a direct-acting, reversible inhibitor and does not need to be activated in the liver by the CYP2C19 enzyme. This is an important pharmacological advantage: up to 30% of some populations carry reduced-function CYP2C19 variants that can markedly lower the response to clopidogrel. Ticagrelor's activity is independent of CYP2C19 genotype, meaning platelet inhibition is more predictable across individuals.
Because ticagrelor binds reversibly to the P2Y12 receptor, platelet function returns to normal more rapidly after treatment is stopped (typically within 3–5 days) than with irreversible inhibitors such as clopidogrel (5–7 days). Ticagrelor also has an active metabolite, AR-C124910XX, which contributes approximately equally to the overall antiplatelet effect. Near-maximal platelet inhibition is achieved within 2 hours of the first oral dose, and steady-state plasma concentrations are reached within 2–3 days of regular twice-daily dosing.
How platelets form dangerous blood clots
Platelets are tiny, disc-shaped blood cells that play a crucial role in stopping bleeding. When a blood vessel is injured, platelets rapidly gather at the wound, become activated, and aggregate to form a plug that seals the damage. This is a normal, life-saving process. However, in patients with atherosclerosis – the gradual build-up of fatty, cholesterol-rich plaques inside artery walls – platelets can be triggered by a ruptured or eroded plaque to form a clot within the artery itself. This intravascular clot, rather than a bleeding wound, is the direct cause of most cardiovascular emergencies.
If a clot fully occludes a coronary artery supplying the heart muscle, it causes a myocardial infarction (heart attack). If it blocks an artery supplying the brain, it causes an ischaemic stroke. Partial blockage may present as episodes of unstable angina or transient ischaemic attacks (TIAs). Ticagrelor Vivanta interrupts this process by preventing the adenosine diphosphate (ADP) signalling pathway that drives platelet aggregation at sites of vascular damage.
Approved indication for Ticagrelor Vivanta 60 mg
The Ticagrelor Vivanta 60 mg formulation is specifically authorised for long-term secondary prevention in adults who have had a myocardial infarction at least 12 months earlier and who remain at elevated risk of a further atherothrombotic event. It is prescribed in combination with low-dose acetylsalicylic acid (aspirin), usually 75–100 mg once daily. This combination, known as dual antiplatelet therapy (DAPT), provides more comprehensive inhibition of platelet activation than either agent alone.
Ticagrelor is manufactured in two strengths. The 90 mg tablet is used during the acute phase of an acute coronary syndrome (ACS) and during the first 12 months after a heart attack. After this initial year, patients who remain at high cardiovascular risk may be switched to the 60 mg strength for extended secondary prevention. The 60 mg dose was specifically studied in the PEGASUS-TIMI 54 trial, which showed a significant reduction in the composite endpoint of cardiovascular death, heart attack, or stroke compared with aspirin alone. Ticagrelor Vivanta is currently available in the 60 mg strength for this long-term prevention indication.
What Should You Know Before Taking Ticagrelor Vivanta?
Before starting Ticagrelor Vivanta, your doctor must evaluate your bleeding risk, current medicines, and liver function. Do not take this medicine if you are allergic to ticagrelor, have active bleeding, have ever had bleeding in the brain, have severe liver disease, or are taking strong CYP3A4 inhibitors such as ketoconazole, clarithromycin, or ritonavir. Tell your doctor about any upcoming surgery, as treatment is usually stopped 5 days before the procedure.
Like all antiplatelet medicines, Ticagrelor Vivanta increases the likelihood of bleeding. It is essential to provide your doctor with a complete medical history and a full list of medicines, including over-the-counter products and herbal supplements, before starting treatment. Certain conditions and drug combinations can dramatically increase the risk of dangerous bleeding or alter the effectiveness of ticagrelor.
Contraindications
You must not take Ticagrelor Vivanta in any of the following situations:
- Allergy to ticagrelor: If you are hypersensitive to ticagrelor or to any of the excipients contained in the tablet
- Active clinically significant bleeding: For example, active peptic ulcer bleeding or other overt haemorrhage
- History of intracranial haemorrhage: If you have ever had a bleeding stroke (haemorrhagic stroke) or bleeding inside the skull
- Severe hepatic impairment: Ticagrelor is extensively metabolised in the liver, so severe liver dysfunction can cause markedly elevated drug levels
- Concomitant strong CYP3A4 inhibitors: Including ketoconazole (antifungal), clarithromycin (antibiotic), nefazodone (antidepressant), ritonavir and atazanavir (HIV protease inhibitors). These drugs dramatically increase ticagrelor plasma levels and the risk of bleeding
Warnings and precautions
Talk to your doctor or pharmacist before taking Ticagrelor Vivanta if any of the following apply:
- Increased bleeding risk: If you have recently had a serious injury, major surgery (including dental procedures), a bleeding disorder, or recent gastrointestinal bleeding such as a stomach or duodenal ulcer or colonic polyps
- Upcoming surgery or dental procedures: If you are scheduled for any elective procedure, your doctor will usually advise stopping Ticagrelor Vivanta 5 days beforehand to reduce peri-operative bleeding. Never stop treatment on your own without medical guidance
- Slow resting heart rate (bradycardia): Particularly if below 60 beats per minute and you do not have a pacemaker, since ticagrelor has been associated with ventricular pauses
- Asthma or COPD: Pre-existing respiratory disease may make the common side effect of dyspnoea more noticeable. This does not necessarily indicate a worsening of lung function but should be reported to your doctor
- Abnormal breathing patterns: Including episodes of fast, slow, or irregular breathing. Your doctor may arrange sleep studies to rule out central sleep apnoea
- Liver problems: No dose adjustment is needed for mild to moderate hepatic impairment, but liver function should be monitored. Severe impairment is an absolute contraindication
- High blood uric acid: If blood tests have shown raised uric acid levels, or you have a history of gout, because ticagrelor can further elevate uric acid
- Renal impairment: No dose adjustment is required, but serum creatinine levels should be monitored, especially in patients over 75 years and those receiving angiotensin receptor blockers
If you are taking Ticagrelor Vivanta together with heparin and your doctor suspects heparin-induced thrombocytopenia (HIT), it is important to inform them that you are taking ticagrelor. Ticagrelor can interfere with some functional laboratory assays used to diagnose HIT, potentially causing false-negative results. Alternative testing methods may be needed.
Pregnancy and breastfeeding
Ticagrelor Vivanta is not recommended during pregnancy. There are insufficient data on the use of ticagrelor in pregnant women, and animal studies have shown reproductive toxicity. Women of childbearing potential should use effective contraception while taking this medicine. If you become pregnant or plan to become pregnant, discuss with your doctor whether treatment should be continued, switched, or stopped.
It is not known whether ticagrelor or its metabolites pass into human breast milk, although animal studies have shown excretion in milk. Because many medicines pass into human milk and because of the potential for serious adverse reactions in nursing infants, a decision must be made whether to discontinue breastfeeding or to discontinue Ticagrelor Vivanta, taking into account the importance of the drug to the mother.
Driving and operating machinery
Ticagrelor Vivanta has no or negligible influence on the ability to drive and use machines. However, dizziness and confusion have been reported. If you experience either of these symptoms, you should avoid driving or operating heavy machinery until the symptoms resolve.
Use in children and adolescents
Ticagrelor Vivanta is not recommended for children and adolescents under 18 years of age. The safety and efficacy of ticagrelor have not been established in this population.
Use in elderly patients
No dose adjustment is required in elderly patients. However, patients over 75 years of age may have an increased baseline risk of bleeding and should be monitored closely during treatment.
How Does Ticagrelor Vivanta Interact with Other Drugs?
Ticagrelor Vivanta has clinically important 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 give your doctor and pharmacist a complete list of all prescription medicines, over-the-counter products, and herbal supplements you use.
Ticagrelor is metabolised primarily by the liver enzyme CYP3A4 and also acts as an inhibitor of CYP3A4 and of P-glycoprotein (P-gp). This means its blood levels can be markedly increased or decreased by other drugs that affect these enzymes, and ticagrelor itself can raise the plasma levels of certain co-prescribed medicines. Understanding these interactions is essential for safe and effective therapy.
Major interactions – contraindicated combinations
The following medicines must not be used together with Ticagrelor Vivanta because they dramatically increase ticagrelor plasma levels and the risk of serious bleeding:
| Drug | Class | Mechanism | Clinical Effect |
|---|---|---|---|
| Ketoconazole | Antifungal | Strong CYP3A4 inhibitor | Increases ticagrelor AUC 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 medicines may interact with Ticagrelor Vivanta and require monitoring or dose adjustment:
| Drug | Effect | Recommendation |
|---|---|---|
| Simvastatin / Lovastatin | Ticagrelor increases simvastatin exposure by ~56%; higher doses increase risk of myopathy and rhabdomyolysis | Do not exceed 40 mg/day of simvastatin or lovastatin |
| Rosuvastatin | Ticagrelor may increase rosuvastatin exposure | Monitor for myalgia and muscle toxicity; consider a lower starting dose |
| Digoxin | Ticagrelor inhibits P-glycoprotein, raising digoxin plasma levels by ~28% | Monitor digoxin levels and watch for signs of toxicity (nausea, visual disturbance, arrhythmia) |
| Cyclosporine | Dual P-gp and CYP3A4 inhibition may increase levels of both drugs | Monitor cyclosporine trough levels and renal function closely |
| Rifampicin | Strong CYP3A4 inducer; reduces ticagrelor AUC by ~86% | Combination discouraged; may eliminate antiplatelet effect |
| Phenytoin / Carbamazepine / Phenobarbital | CYP3A4 inducers; substantially reduce ticagrelor exposure | Avoid combination if possible; consider alternative antiplatelet |
| Morphine / Other Opioids | Opioids delay gastric emptying, slowing ticagrelor absorption by ~36% | In acute settings, consider IV P2Y12 inhibitor (cangrelor) when opioids are co-administered |
| Diltiazem / Verapamil | Moderate CYP3A4 inhibitors; modestly increase ticagrelor levels | No dose adjustment usually required; monitor for bleeding |
| Beta-blockers | Additive bradycardic effect | Monitor heart rate, especially in patients with pre-existing bradycardia |
Bleeding-risk interactions
The following medicines increase the risk of bleeding when taken alongside Ticagrelor Vivanta and require particular caution:
- Oral anticoagulants (warfarin, DOACs): Concurrent use with warfarin, rivaroxaban, apixaban, edoxaban, or dabigatran markedly increases the risk of major bleeding. Combination therapy should only be prescribed under specialist supervision with a clear plan for duration and monitoring
- NSAIDs (ibuprofen, naproxen, diclofenac): Non-steroidal anti-inflammatory drugs raise the risk of gastrointestinal bleeding and can impair kidney function. Use the lowest effective dose for the shortest time, and consider a proton pump inhibitor for gastroprotection
- SSRIs/SNRIs: Paroxetine, sertraline, citalopram, venlafaxine and other serotonergic antidepressants impair platelet function and may increase bleeding risk when combined with antiplatelet agents
- Fibrinolytic agents (streptokinase, alteplase, tenecteplase): If you require clot-dissolving therapy – for example during a stroke – ensure medical staff know you are taking ticagrelor, as the combination substantially increases bleeding risk
The landmark PLATO trial found that aspirin doses above 100 mg daily were associated with reduced effectiveness of ticagrelor compared with lower doses. Current international guidelines therefore recommend that the maintenance aspirin dose does not exceed 100 mg daily when combined with ticagrelor. Most guidelines suggest 75–100 mg daily for optimal clinical benefit and lowest bleeding risk.
What Is the Correct Dosage of Ticagrelor Vivanta?
The recommended dose of Ticagrelor Vivanta for long-term secondary prevention after a heart attack is one 60 mg film-coated tablet taken twice daily (morning and evening), combined with low-dose aspirin (75–100 mg once daily). Tablets can be taken with or without food and should be swallowed whole or, if swallowing is difficult, crushed and mixed with water.
Always take Ticagrelor Vivanta exactly as prescribed by your doctor. Do not change the dose or stop the medicine on your own. Consistency in timing is important because a missed or delayed dose temporarily reduces platelet inhibition and therefore increases clot risk in the hours before the next tablet is taken.
Adults
Standard dosing regimen
Ticagrelor Vivanta 60 mg: One tablet twice daily (total daily dose 120 mg)
Combined with aspirin: 75–150 mg once daily – ideally 75–100 mg for best ticagrelor effectiveness
Timing: Take one tablet in the morning and one in the evening, approximately 12 hours apart, at the same times each day
With food: Ticagrelor Vivanta may be taken with or without food
Many ticagrelor blister packs feature sun and moon symbols to help patients track their morning and evening doses. This can be a useful memory aid, particularly at the start of treatment, but any pill organiser or phone reminder system works equally well.
Difficulty swallowing
If you have difficulty swallowing whole tablets, Ticagrelor Vivanta can be taken as follows:
- Crush the tablet into a fine powder
- Mix the powder with half a glass of water
- Stir briefly and drink the mixture immediately
- Refill the empty glass with another half glass of water, swirl and drink the rinse to ensure the full dose is taken
For hospitalised patients who cannot take oral medicines, the same crushed-tablet suspension can be administered via a nasogastric tube (CH8 or larger) directly into the stomach, followed by a water flush.
Children and adolescents
Ticagrelor Vivanta is not recommended for children and adolescents under 18 years of age. There are no adequate clinical data on safety and efficacy in paediatric populations, and indications for long-term antiplatelet therapy in this age group are rare.
Elderly patients
No dose adjustment is required for elderly patients. Ticagrelor has been studied in patients up to and beyond 75 years of age, including in the PEGASUS-TIMI 54 trial, which enrolled a substantial proportion of elderly participants. However, older patients may have a higher baseline risk of bleeding due to comorbidity and polypharmacy, so the decision to treat should weigh individual cardiovascular benefit against bleeding risk.
Renal impairment
No dose adjustment is necessary for patients with kidney disease, including those on haemodialysis, because ticagrelor is primarily cleared by the liver. Clinical experience in end-stage renal disease is limited, so caution is warranted and serum creatinine should be monitored.
Hepatic impairment
No dose adjustment is needed in mild to moderate hepatic impairment. Ticagrelor Vivanta is contraindicated in patients with severe hepatic impairment because the drug is extensively metabolised by the liver and severe dysfunction would lead to markedly elevated plasma levels and excessive bleeding risk.
Missed dose
If you forget a dose of Ticagrelor Vivanta, take your next dose at the normally scheduled time. Do not take a double dose to make up for the missed one – doubling does not provide extra protection but does increase bleeding risk. Taking doses regularly at the same times every day greatly improves adherence and clinical outcomes.
Overdose
If you take more Ticagrelor Vivanta than prescribed, contact your doctor or go to the nearest hospital emergency department immediately. Bring the medicine packaging with you so that staff can see which product you have taken. 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 high protein binding. Treatment is symptomatic and supportive, with platelet transfusion if life-threatening bleeding occurs.
Stopping Ticagrelor Vivanta prematurely without consulting your doctor significantly increases the risk of another heart attack, stroke, or cardiovascular death. Continue taking this medicine for as long as your doctor prescribes it. If treatment must be paused for a reason such as planned surgery, your doctor will provide individualised instructions, typically stopping the drug 5 days before the procedure and restarting as soon as it is safe to do so.
What Are the Side Effects of Ticagrelor Vivanta?
The most common side effects of Ticagrelor Vivanta are bleeding events (bruising, nosebleeds, heavier menstrual or wound bleeding), dyspnoea (shortness of breath) and elevated blood uric acid. Most bleeding events are mild, but serious and potentially life-threatening bleeding can occur. Dyspnoea is typically mild, occurs at rest, and often resolves within the first few weeks of treatment.
Like all medicines, Ticagrelor Vivanta can cause side effects, although not everyone will experience them. Because ticagrelor's mechanism of action is to reduce platelet function, most adverse effects are related to bleeding. Mild bleeding – for example, bruising more easily, nosebleeds, or heavier bleeding from cuts and shaving nicks – is common and expected. Severe bleeding is uncommon but can be life-threatening and requires immediate medical attention.
Signs of stroke: Sudden numbness or weakness of the face, arm, or leg (especially on one side), sudden confusion, difficulty speaking or understanding speech, sudden difficulty walking, loss of balance or coordination, sudden dizziness, or a 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 material that looks like coffee grounds, red, black, or tarry stools, or coughing up blood.
Signs of thrombotic thrombocytopenic purpura (TTP): Fever, small purple spots on the skin or in the mouth, with or without yellowing of the skin or eyes (jaundice), and unexplained extreme tiredness, weakness, or confusion.
Very Common
- Dyspnoea (shortness of breath) – usually mild, occurs at rest, often resolves within weeks
- Elevated uric acid levels in the blood (hyperuricaemia, detected on laboratory tests)
- Bleeding manifestations due to impaired platelet function
Common
- Bruising (ecchymosis) appearing more easily than usual
- Headache
- Dizziness or vertigo (spinning sensation)
- Diarrhoea or indigestion (dyspepsia)
- Nausea and/or vomiting
- Constipation
- Skin rash
- Itching (pruritus)
- Severe joint pain and swelling – signs of gout related to raised uric acid
- Low blood pressure (hypotension) with dizziness, light-headedness, or blurred vision
- Nosebleed (epistaxis)
- Heavier than normal bleeding after surgery or from wounds (including shaving cuts)
- Gastrointestinal bleeding (bleeding from the stomach or bowel lining)
- Bleeding gums while brushing teeth
- Syncope (fainting) due to reduced blood flow to the brain
Uncommon
- Allergic reactions such as skin rash, itching, or swelling of the face, lips, or tongue
- Confusion
- Visual disturbances caused by bleeding into the eye
- Vaginal bleeding that is heavier than normal or occurs at unexpected times
- Bleeding into joints and muscles causing painful swelling
- Bleeding from the ear (otorrhagia)
- Internal bleeding, which may present as dizziness or light-headedness
- Tingling or numbness (paraesthesia)
Rare
- Serious, extensive bleeding (intracranial, retroperitoneal, or pericardial haemorrhage)
- Severe allergic reaction including anaphylactic shock with difficulty breathing
- Angioedema (deep swelling of tissues, particularly around the mouth and throat)
Not Known
- Abnormally slow heart rate (bradycardia, usually below 60 beats per minute)
- Thrombotic thrombocytopenic purpura (TTP) – a rare but serious blood disorder
Dyspnoea (shortness of breath) – a distinctive ticagrelor effect
Dyspnoea is one of the most recognisable side effects of ticagrelor and deserves special consideration. It occurs in approximately 14% of patients overall and is more common with the 90 mg dose than with the 60 mg dose used for long-term prevention. The breathlessness is usually described as a sudden, unexpected sense of needing more air. It typically occurs at rest rather than during exertion and is mild in most patients.
The underlying mechanism is thought to involve inhibition of adenosine reuptake through the equilibrative nucleoside transporter 1 (ENT1). By blocking adenosine reuptake, ticagrelor increases local extracellular adenosine levels, which can stimulate sensory nerve fibres in the lungs and create a sensation of breathlessness. Importantly, formal lung function testing shows no deterioration in respiratory parameters, confirming that ticagrelor-related dyspnoea does not reflect worsening heart or lung disease.
In most patients the symptom appears within the first weeks of treatment and resolves spontaneously as the body adapts. If shortness of breath becomes severe, occurs with exertion, or is accompanied by chest pain, wheezing, or ankle swelling, contact your doctor promptly because these features may suggest a different underlying cause that warrants evaluation, such as heart failure, pulmonary embolism, or worsening coronary disease.
Reporting side effects
If you experience any side effects while taking Ticagrelor Vivanta, talk to your doctor or pharmacist. This includes any possible side effects not listed above. Patients and healthcare professionals can also report suspected adverse drug reactions to national pharmacovigilance systems (such as the EMA EudraVigilance database in the EU or the FDA MedWatch programme in the United States), which contributes to the ongoing monitoring of medicine safety.
How Should You Store Ticagrelor Vivanta?
Store Ticagrelor Vivanta at room temperature with no special storage conditions required. Keep the tablets in the original blister packaging to protect them from moisture and light, and keep out of the sight and reach of children. Do not use tablets after the expiry date printed on the carton or blister.
Ticagrelor Vivanta tablets do not require any special storage conditions. They should be kept at normal room temperature, away from extreme heat, humidity, and direct sunlight. A bedside cabinet or drawer that stays relatively dry is typically suitable, whereas bathrooms and areas near cookers are best avoided due to fluctuating humidity and temperature.
Keep the tablets in their original blister pack until you are ready to take a dose. The blister foil provides an effective barrier against moisture and light and helps preserve the stability of the active ingredient until the expiry date. Do not transfer tablets to unlabelled pill bottles, as this may accelerate degradation and also create a safety risk if the medicine is confused with another product.
Always check the expiry date (marked “EXP”) on the carton and blister before taking a tablet. The expiry date refers to the last day of the stated month. Do not use Ticagrelor Vivanta after this date, because the medicine may have degraded and become less effective or, rarely, unsafe.
Keep all medicines out of the sight and reach of children. Do not dispose of unused or expired tablets through household waste or the plumbing system. Return them to your pharmacy for safe disposal, which helps protect the environment from pharmaceutical contamination.
What Does Ticagrelor Vivanta Contain?
Each Ticagrelor Vivanta 60 mg film-coated tablet contains 60 mg of the active substance ticagrelor. The tablets also contain inactive ingredients (excipients) that form the tablet core and film coating. The exact appearance – colour, shape, and markings – differs from the reference product Brilique, because generic manufacturers use their own formulation and tablet design.
The active substance in Ticagrelor Vivanta is ticagrelor. Each film-coated tablet contains 60 mg of ticagrelor, the same amount as in the originator product Brilique 60 mg.
Inactive ingredients (excipients)
Generic ticagrelor products contain various excipients that form the tablet core and film coating. Typical examples of excipients used in approved ticagrelor generics include:
- Tablet core: Mannitol (E421), calcium hydrogen phosphate, sodium starch glycolate, hydroxypropyl cellulose (E463), magnesium stearate (E470b), microcrystalline cellulose
- Film coating: Hypromellose (E464), titanium dioxide (E171), macrogol/polyethylene glycol, iron oxide colourants (E172), talc (E553b)
The precise list of excipients for Ticagrelor Vivanta is provided in the package leaflet accompanying the medicine. If you have a known allergy or intolerance to any excipient, carefully check the leaflet before starting a new pack.
Appearance and packaging
Ticagrelor Vivanta 60 mg tablets are film-coated and, in line with regulatory requirements, may differ in colour, shape, size, and markings from Brilique tablets. Generic manufacturers are legally required to differentiate their products visually from the originator, partly to avoid medication errors and partly to comply with trade-mark law. The clinical effect, however, remains the same. Typical pack sizes for ticagrelor generics include 14, 56, 60, and 168 tablets in blister strips, though not all pack sizes may be marketed in every country.
Sodium content
Ticagrelor Vivanta tablets contain less than 1 mmol (23 mg) sodium per tablet, which means they are considered essentially ‘sodium-free’. This is relevant for patients on sodium-restricted diets, including those with heart failure or chronic kidney disease.
Bioequivalence and generic quality standards
Before a generic medicine such as Ticagrelor Vivanta can be authorised, the manufacturer must demonstrate bioequivalence to the reference product. This is done in formal pharmacokinetic studies in healthy volunteers, in which the generic and the originator are compared after single-dose administration. The rate and extent of absorption (Cmax and AUC) of the generic must fall within the accepted 80–125% confidence interval of the reference product. In addition, the generic must meet the same strict manufacturing standards (Good Manufacturing Practice, GMP) and quality controls – including content uniformity, dissolution, and impurity profiles – as the originator.
These regulatory requirements, overseen by authorities such as the European Medicines Agency (EMA), the US Food and Drug Administration (FDA), and the UK MHRA, ensure that approved generic ticagrelor products are clinically interchangeable with Brilique. Healthcare systems worldwide rely on high-quality generic medicines to provide cost-effective access to essential cardiovascular therapies.
Frequently Asked Questions About Ticagrelor Vivanta
Ticagrelor Vivanta 60 mg is a generic antiplatelet medicine used in combination with low-dose aspirin to prevent further heart attacks, strokes, or cardiovascular death in adults who have had a heart attack more than one year ago. It contains the same active ingredient (ticagrelor) as the reference product Brilique and is prescribed as part of long-term dual antiplatelet therapy in patients who remain at high cardiovascular risk.
Yes, Ticagrelor Vivanta contains the same active substance (ticagrelor) in the same strength (60 mg) and dosage form (film-coated tablet) as the originator product Brilique. As an approved generic, it has undergone bioequivalence testing demonstrating that it delivers the active drug to the bloodstream at the same rate and extent as Brilique. It is therefore considered therapeutically equivalent and clinically interchangeable. Inactive ingredients, tablet colour, and shape may differ, but the clinical effect is the same.
Take one 60 mg Ticagrelor Vivanta tablet twice daily – once in the morning and once in the evening, approximately 12 hours apart – together with low-dose aspirin (75–100 mg once daily) as prescribed by your doctor. Tablets can be taken with or without food and should be swallowed whole with a glass of water. If swallowing is difficult, the tablet can be crushed, mixed with water, and taken immediately. Try to take your doses at the same times every day to maintain steady platelet inhibition.
Dyspnoea (shortness of breath) is a well-known and distinctive side effect of ticagrelor, affecting up to 14% of patients. Research suggests it results from ticagrelor's inhibition of adenosine reuptake via the equilibrative nucleoside transporter 1 (ENT1), which increases local adenosine concentrations and stimulates lung sensory nerves. The breathlessness is typically mild, occurs at rest rather than with exertion, and often resolves spontaneously within the first weeks of treatment. Lung function remains normal, so this side effect does not reflect worsening heart or lung disease. Tell your doctor if shortness of breath becomes severe or is accompanied by chest pain, wheezing, or ankle swelling.
Yes – Ticagrelor Vivanta is specifically designed to be taken together with low-dose aspirin (75–150 mg daily) as dual antiplatelet therapy (DAPT). However, the aspirin maintenance dose should ideally not exceed 100 mg daily, as higher doses have been associated with reduced effectiveness of ticagrelor in the PLATO trial. Your doctor will advise you on the correct aspirin dose to use alongside Ticagrelor Vivanta. Do not add extra aspirin or other antiplatelet medicines on your own.
If you miss a dose, simply take your next dose at the regular scheduled time. Do not take a double dose to make up for the forgotten tablet. Taking a double dose does not improve protection but increases bleeding risk. To help remember your doses, take one tablet in the morning and one in the evening at approximately the same times each day, and consider using a pill organiser, phone alarm, or reminder app. If you frequently forget doses, talk to your doctor or pharmacist about strategies to improve adherence.
Ticagrelor Vivanta 60 mg is prescribed for long-term secondary prevention in patients who have had a heart attack more than one year ago. The treatment duration is determined by your doctor based on your individual cardiovascular risk and bleeding risk profile. The PEGASUS-TIMI 54 trial demonstrated continued cardiovascular benefit with treatment lasting up to 3 years, and many patients remain on therapy for even longer. Never stop taking Ticagrelor Vivanta without consulting your doctor, because 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
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