Ticagrelor - Brand name: Brilique

Ticagrelor is an antiplatelet medicine. It makes your blood flow through your veins more easily. This means your blood will be less likely to make a dangerous blood clot.

Taking ticagrelor can help prevent blood clots if you have an increased risk of having them.

Your risk is higher if you have:

• unstable angina
• had a heart attack

Ticagrelor is only available on prescription. It comes as tablets or melt in the mouth tablets.

• You'll usually take ticagrelor twice a day.
• Ticagrelor is often prescribed together with low-dose aspirin.
• The most common side effects of ticagrelor are getting out of breath and bleeding more easily than normal. You may have nosebleeds, heavier periods, bleeding gums and bruising.
• You can drink alcohol with ticagrelor. But do not drink too much as it can irritate your stomach.
• You may need to stop taking ticagrelor for a short time before having surgery or dental treatment, but check with your doctor or dentist first.

Ticagrelor can be taken by adults aged 18 and over.

Ticagrelor is not suitable for some people. To make sure this medicine is safe for you, tell your doctor if you:

• have ever had an allergic reaction to ticagrelor or any other medicine
• have any injuries that are currently bleeding a lot, such as a wound
• have a stomach ulcer
• have breathing difficulties, such as asthma or chronic obstructive pulmonary disease (COPD)
• have an abnormal heart rate (arrhythmia)
• have previously had a stroke caused by bleeding in the brain
• have gout or high levels of a chemical called uric acid in your body
• have liver problems
• are trying to get pregnant, already pregnant or breastfeeding

Always follow your doctor's instructions when taking ticagrelor.

Dosage

Ticagrelor comes as 90mg tablets. It's also available as 60mg tablets for people who need a lower dose.

On your first day of treatment, your pharmacist will give you two 90mg tablets to take at the same time. After this, the usual dose is 90mg twice a day for 12 months.

If you have had a heart attack, your doctor may advise you to keep on taking ticagrelor after you've finished the 12-month course of treatment. You'll usually take a lower dose of 60mg, twice a day, for up to 3 years.

How and when to take ticagrelor

When you start taking ticagrelor, you'll take 1 dose on your first day.

After this, most people take ticagrelor twice a day, usually once in the morning and once in the evening.

You can take ticagrelor with or without food.

If you're taking melt in the mouth tablets, put the tablet on your tongue and let it dissolve. You can then swallow it with or without water.

What if I forget to take it?

If you forget to take ticagrelor, take it as soon as you remember. If it's nearly time for your next dose, skip the missed dose and take your next dose at the usual time.

Do not take a double dose to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking 1 or 2 extra tablets is unlikely to harm you.

But the amount of ticagrelor that can lead to overdose is different for everyone.

Contact your doctor if you have taken some extra tablets and notice any signs of bleeding.

Like all medicines, ticagrelor can cause side effects, although not everyone gets them.

Common side effects

These common side effects happen in more than 1 in 100 people.

Talk to your doctor or pharmacist if these side effects bother you or do not go away:

• bleeding more easily than normal – nosebleeds, bruising or bleeding that takes longer to stop
• unexpected shortness of breath while resting – this can sometimes happen in the first few weeks of taking ticagrelor and is usually mild
• pain and swelling in your joints – these can be signs of gout (this is because ticagrelor can lead to high levels of uric acid in your blood)
• headaches
• dizziness
• feeling sick or indigestion
• diarrhoea
• constipation
• mild rash

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Tell a doctor as soon as possible if you are coughing up blood, or there's blood in your pee, poo or vomit. This needs to be checked out as these are signs of internal bleeding.

Serious allergic reaction

In rare cases, ticagrelor can cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of ticagrelor. For a full list, see the leaflet inside your medicines packet.

What to do about:

• bleeding more easily than normal – be careful when doing activities that might cause an injury or a cut. Always wear a helmet when cycling. Wear protective gloves when you use sharp objects like scissors, knives, and gardening tools. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth. See a doctor if you're worried about any bleeding.
• shortness of breath – try breathing in slowly through your nose and out through your mouth. Sitting on a chair and leaning your chest slightly forward may also help. Your breathing will usually return to normal within a few weeks of starting ticagrelor. Tell your doctor if your symptoms do not improve or they get worse. Shortness of breath can also be a sign of an ongoing or worsening heart problem.
• pain and swelling in your joints – if you get unusual muscle pain, weakness or tiredness which is not from exercise or hard work, talk to your doctor. You may need a blood test to check what might be causing it.
• headaches – make sure you rest and drink plenty of fluids, but do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. If your headaches last longer than a week or are severe, talk to your doctor.
• dizziness – if ticagrelor makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better. Do not drive, cycle or use any tools or machinery if you're dizzy, have muscle cramps or muscle pain, or are feeling a bit shaky.
• feeling sick or indigestion – try taking your tablets with a meal or snack, or shortly after eating. It may also help if you avoid eating rich or spicy food. If you have indigestion that does not go away, it could be a sign that you have a stomach ulcer. Talk to your doctor, as they may prescribe something to protect your stomach or switch you to a different medicine.
• diarrhoea – drink lots of fluids, such as water or squash, to avoid dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. If you take the combined contraceptive pill or progestogen-only pill and you have severe diarrhoea for more than 24 hours , your contraception may not protect you from pregnancy. Check the pill packet for advice. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
• constipation – get more fibre into your diet, such as fresh fruit, vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example by going for a daily walk or run. If this does not help, talk to your pharmacist or doctor. Watch this short video about how to treat constipation.
• mild rash – it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you while you are on this medicine.

Ticagrelor and pregnancy

Ticagrelor is not recommended during pregnancy or if you're trying to get pregnant.

It's important to use contraception while you're taking ticagrelor to avoid becoming pregnant.

Talk to your doctor if you take ticagrelor and are trying to get pregnant. They may be able to recommend a more suitable medicine for you.

Ticagrelor and breastfeeding

Only take ticagrelor while breastfeeding if your doctor advises you to.

It's not known how much ticagrelor gets into breast milk, but it's likely to be a small amount, and your baby will not absorb a lot into their body from the breast milk.

If your doctor says it's OK for you to keep taking ticagrelor, then monitor your baby for any possible side effects, such as bruises or bleeding more easily than usual. However, it is unlikely that ticagrelor will cause any side effects in your baby.

Talk to your doctor, pharmacist, midwife or health visitor if you have any concerns about your baby while you're breastfeeding.

Some medicines affect the way ticagrelor works.

Tell your doctor if you're taking any of these medicines before you start taking ticagrelor:

• medicines to prevent blood clots, such as low-dose aspirin, warfarin, rivaroxaban or apixaban
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as citalopram
• some antibiotics like clarithromycin and rifampicin
• medicines for epilepsy, such as phenytoin and carbamazepine
• statins, such as simvastatin, used to lower cholesterol
• digoxin, for heart problems

Taking ticagrelor with everyday painkillers

Your doctor may prescribe low-dose aspirin (75mg tablets) to take together with ticagrelor.

Do not take aspirin for pain relief (300mg tablets) or ibuprofen while you're taking ticagrelor, unless a doctor has said it's OK. They increase the chance of bleeding.

You can take paracetamol together with ticagrelor.

Mixing ticagrelor with herbal remedies and supplements

There might be a problem with taking some herbal remedies and supplements with ticagrelor, especially ones that can affect your blood (for example, ginkgo).

St John's wort (used for depression) can reduce the levels of ticagrelor in your blood. This may stop ticagrelor from working properly and increase your chances of getting a blood clot.