Brilinta

Common Uses

Brilinta is primarily prescribed to prevent serious cardiovascular events in adults. It is commonly used in the following situations:

• Heart Attack and Chest Pain: To lower the risk of another heart attack or death in people who have recently had a heart attack or severe chest pain known as unstable angina.
• Stent Procedures: To prevent blood clots from forming in stents, which are small tubes placed in the heart's arteries to keep them open.
• Coronary Artery Disease: To reduce the risk of a first heart attack or stroke in people with coronary artery disease who are at high risk for these events.
• Stroke and TIA: To lower the risk of a subsequent stroke in people who have had a recent ischemic stroke or a transient ischemic attack (TIA), also known as a mini-stroke.

This medication is often used in combination with a low dose of aspirin to help keep blood flowing smoothly through the body and prevent platelets from sticking together to form dangerous clots.

Preventing Blood Clots

Brilinta is a type of medicine called an antiplatelet drug. It works by preventing certain blood cells, called platelets, from sticking together. While clotting is a normal process that stops bleeding after an injury, it can be dangerous if clots form inside blood vessels, as they can block blood flow to the heart or brain.

Blocking Platelet Activation

The medication targets a specific receptor on the surface of platelets known as the P2Y12 receptor. Usually, a chemical in the body binds to this receptor to signal platelets to clump together. Brilinta blocks this chemical signal, which makes the platelets less sticky and reduces the risk of a heart attack or stroke in people with heart disease or those who have recently had a heart procedure.

Reversible Binding

Unlike some other antiplatelet medications that permanently affect platelets for their entire lifespan, Brilinta interacts with platelets in a reversible way. This means the effect on the platelets wears off more quickly once the medication is no longer in the system, allowing the blood's natural clotting ability to return as the drug is cleared from the body.

Common Side Effects

• Shortness of breath
• Easy bruising or minor bleeding, such as nosebleeds
• Dizziness
• Nausea
• Diarrhea
• Headache

Serious Side Effects

Contact a healthcare provider immediately if you experience any of the following serious symptoms:

• Severe or uncontrollable bleeding
• Coughing up blood or vomit that looks like coffee grounds
• Red, pink, or brown urine
• Black, bloody, or tarry stools
• Signs of an allergic reaction, including rash, hives, or swelling of the face, lips, or tongue
• Chest pain or a fast, irregular heartbeat

Boxed Warnings

Bleeding Risk: Brilinta can cause significant and sometimes fatal bleeding. Because it prevents blood clots, it also increases the risk of hemorrhage. It should not be used in people with active pathological bleeding, such as a bleeding ulcer, or those with a history of intracranial hemorrhage (bleeding in the brain).

Aspirin Dosage: The effectiveness of Brilinta is reduced when taken with maintenance doses of aspirin above 100 mg per day. For most patients, a daily aspirin dose of 75 mg to 100 mg is recommended to maintain the drug's efficacy.

Other Serious Precautions

Shortness of Breath: Many patients experience dyspnea (shortness of breath) while taking this medication. This symptom is usually mild to moderate and often resolves without stopping the drug, but medical evaluation may be necessary if it persists or worsens.

Heart Rate Slowing: Brilinta may cause the heart rate to slow down (bradyarrhythmia), which can lead to fainting or heart palpitations. Caution is advised for patients with a history of heart rhythm problems or those taking other medications that slow the heart rate.

Surgery and Procedures: To minimize the risk of excessive bleeding, healthcare providers typically recommend stopping Brilinta five days before any scheduled surgery or dental procedure. The medication should be restarted as soon as possible after the risk of bleeding has passed.

Liver Function: This medication is not recommended for patients with severe liver impairment. Because the liver is responsible for processing the drug, impairment can lead to increased levels of the medication in the bloodstream, raising the risk of side effects.

Laboratory Changes: Brilinta may cause increases in uric acid levels or serum creatinine. Monitoring of kidney function and assessment for gout symptoms may be appropriate during treatment.

Pregnancy

There are no adequate or well-controlled studies regarding the use of Brilinta in pregnant women. In animal studies, high doses of the medication were associated with some developmental issues in the fetus, such as lower birth weight and bone variations. Because human data is limited, Brilinta should only be used during pregnancy if the potential benefit to the mother outweighs the potential risk to the unborn baby.

Breastfeeding

It is not known whether Brilinta passes into human breast milk. However, studies in animals have shown that the medication is present in the milk of lactating rats. Due to the risk of serious side effects in a nursing infant, healthcare providers typically recommend either stopping breastfeeding or stopping the medication, depending on the mother's medical needs. Patients should consult their doctor to determine the safest course of action.

Available Forms

Brilinta is supplied as a film-coated tablet intended for oral administration. These tablets are round and biconvex in shape.

For patients who have difficulty swallowing the medication whole, the tablets may be crushed and mixed with water. This mixture can be taken by mouth or administered through a nasogastric tube as directed by a healthcare provider.

FDA Approval and Indications

The U.S. Food and Drug Administration (FDA) has approved Brilinta (ticagrelor) for several uses related to cardiovascular health. It is indicated to reduce the rate of cardiovascular death, heart attack, and stroke in patients with acute coronary syndrome or a history of heart attack. It is also approved for use in patients with coronary artery disease who are at high risk for a first heart attack or stroke, and for certain patients who have experienced an acute ischemic stroke or high-risk transient ischemic attack (TIA).

Boxed Warnings

Brilinta carries a Boxed Warning, the FDA’s most serious type of warning, for the following risks:

• Bleeding Risk: Brilinta can cause significant, and sometimes fatal, bleeding. It should not be used in patients with active pathological bleeding or a history of intracranial hemorrhage. Because it prevents clotting, it may also need to be discontinued before elective surgery.
• Aspirin Dosage: The effectiveness of Brilinta is reduced when used with maintenance doses of aspirin above 100 mg daily. For patients taking Brilinta, the recommended maintenance dose of aspirin is 81 mg daily.

Safety Communications

The FDA previously issued a safety communication to address concerns regarding medication errors. There were reports of confusion between the brand name Brilinta and the antidepressant Brintellix. To reduce the risk of prescribing and dispensing errors, the manufacturer of the antidepressant changed its name to Trintellix.

The FDA also monitors the drug through the FDA Adverse Event Reporting System (FAERS). For example, the agency has previously evaluated potential signals of serious risks, such as central sleep apnea, to determine if further regulatory action or label changes were necessary based on post-marketing data.

Insurance and Generic Availability

Brilinta is a brand-name medication, and generic versions (ticagrelor) are also available. Generic drugs usually cost significantly less than their brand-name counterparts. Coverage for Brilinta varies by insurance provider and specific plan details, such as deductibles and copay tiers.

Cost Considerations

The final price a patient pays may be influenced by several factors:

• Pharmacy Choice: Different pharmacies may have different retail prices for the same medication.
• Assistance Programs: Financial assistance or savings programs may be available for eligible patients to help reduce out-of-pocket expenses.
• Supply Quantity: The amount of medication dispensed at one time can sometimes impact the overall cost.

Patients are encouraged to consult with their pharmacist or insurance company to understand the specific costs associated with their prescription.