You will be given two 90 mg tablets to take as your first dose. After this, take one 90 mg tablet twice a day, preferably in the morning and evening.
It is likely you will be prescribed ticagrelor for a period of up to twelve months. If there is a need for you to take it for longer than this, your dose will be reduced to 60 mg twice daily.
The most common unwanted effects are an increased risk of bleeding, and feeling short of breath.
About ticagrelor tablets
|Type of medicine||An antiplatelet medicine|
|Used for||Preventing clots from forming in blood vessels (in people with acute coronary syndrome or in people who have previously had a heart attack)|
|Available as||Tablets and melt-in-the-mouth (orodispersible) tablets|
In your blood there are 'sticky' cells called platelets. When you cut yourself, the platelets stick to each other (clot) to seal the wound. Sometimes platelets stick to each other inside an artery - this is called a thrombus. If a thrombus forms in a blood vessel around your heart, this reduces the flow of blood to your heart. The term acute coronary syndrome (ACS) covers a range of disorders that are caused by this underlying problem. It may mean that you have had a heart attack, or that you have angina pain that is not well controlled. Antiplatelet medicines reduce the stickiness of platelets, and this helps prevent the platelets from sticking to the inside of an artery and forming a thrombus. This reduces the chances of you having a heart attack or stroke.
Ticagrelor is an antiplatelet medicine. Your doctor will also prescribe aspirin for you to take alongside ticagrelor. Aspirin is another antiplatelet medicine. A course of treatment with ticagrelor typically lasts for up to 12 months, whereas treatment with aspirin is likely to be lifelong.
If you require a procedure to open a blocked artery in your heart because you have already had a heart attack or because you have unstable angina, you could be given a single dose of ticagrelor during the procedure.
Before taking ticagrelor tablets
Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking ticagrelor tablets it is important that your doctor knows:
- If you have a condition which causes bleeding, such as a recent wound or a stomach ulcer.
- If you have any breathing difficulties, such as asthma or chronic obstructive pulmonary disease (COPD). Ticagrelor can make these conditions worse.
- If you have any other heart condition, or an abnormal heart rate.
- If you have ever had a stroke caused by bleeding in your brain, a condition called intracranial haemorrhage.
- If you have ever been told you have high blood levels of uric acid, or gout.
- If you are pregnant or breastfeeding.
- If you have any problems with the way your liver works.
- If you have ever had an allergic reaction to a medicine.
- If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
How to take ticagrelor tablets
- Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about ticagrelor, and it will also provide you with a full list of the side-effects which you could experience from taking it.
- Take the tablets exactly as your doctor tells you to. On the first day of treatment, you will be given two 90 mg tablets to take at the same time so that you get sufficient medicine into your bloodstream to begin with. After this, you will be prescribed a dose of 90 mg twice a day. A course of treatment with ticagrelor often lasts for up to 12 months. If you have had a heart attack, your doctor may want you to continue to take ticagrelor even after the 12-month course has finished. If so, it will be at a lower dose of 60 mg twice daily.
- Try to take your doses around the same times of day each day, preferably in the morning and the evening. This will help you to remember to take ticagrelor regularly.
- Most people find that they can swallow the tablet whole with a drink of water. However, you can crush the tablet into a fine powder and take it stirred into a small glass of water if you prefer, providing that you swallow the mixture straight after making it.
- For people who have swallowing difficulties there is also a melt-in-the-mouth (orodispersible) tablet. If you have been prescribed this tablet, tear open the blister foil and carefully remove the tablet. Place the tablet on your tongue where it will dissolve in a few seconds. You can swallow it with or without a drink of water. It is a good idea to have a few sips of water before taking your tablet, so that your mouth is moist. Make sure your hands are dry when handling the tablet.
- You can take ticagrelor tablets either with or without food.
- If you forget to take a dose, take it as soon as you remember, unless it is nearly time for your next dose. In which case take the next dose when it is due and leave out the forgotten dose. Do not take two doses together to make up for a missed dose.
Getting the most from your treatment
- Try to keep all your regular appointments with your doctor. This is so your doctor can check on your progress.
- If you buy any medicines, check with a pharmacist that they are suitable for you to take with ticagrelor tablets. Some medicines, called non-steroidal anti-inflammatory drugs (NSAIDs), can increase the risk of bleeding, so check with a pharmacist before you buy any painkillers. Also, do not take any preparations containing aspirin that have not been prescribed for you by your doctor. Several medicines for pain relief and cold relief that can be bought at retail outlets contain aspirin or ibuprofen - you should not take these, so check the label carefully before you buy.
- If you are due to have an operation, before the treatment is due, tell the person carrying out the treatment that you are taking ticagrelor. This is because any bleeding may take longer than normal to stop so your treatment may need to be interrupted for a short while before the operation. You should also let your dentist know that you are taking ticagrelor before you receive any dental treatment.
Can ticagrelor tablets cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the more common ones associated with ticagrelor. The best place to find a full list of the side-effects which can be associated with your medicine, is from the manufacturer's printed information leaflet supplied with the medicine. Alternatively, you can find an example of a manufacturer's information leaflet in the reference section below. Speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Very common ticagrelor side-effects (these affect more than 1 in 10 people)||What can I do if I experience this?|
|Feeling short of breath||Let your doctor know if this becomes troublesome|
|Bleeding, bruising, nosebleeds. Stopping bleeding could take longer than normal||Let your doctor know if you notice any unusual or unexpected bleeding or bruising|
|High levels of uric acid (a symptom of gout)||Your doctor may check for this|
|Common ticagrelor side-effects (these affect less than 1 in 10 people)||What can I do if I experience this?|
|Feeling dizzy or faint||If troublesome, speak with your doctor|
|Headache||Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, speak with your doctor|
|Gastric upset (such as feeling sick (nausea), indigestion, constipation or diarrhoea)||If troublesome, speak with your doctor|
|Skin rash||If troublesome, speak with your doctor|
If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.
How to store ticagrelor tablets
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Further reading and references
Manufacturer's PIL, Brilique® 90 mg film-coated tablets; AstraZeneca UK Limited, The electronic Medicines Compendium. Dated September 2019.
Manufacturer's PIL, Brilique® 90 mg orodispersible tablets; AstraZeneca UK Limited, The electronic Medicines Compendium. Dated September 2019.
British National Formulary, 78th Edition (Sep 2019); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.