Ticagrelor

Antiplatelet·Haematology - Antiplatelets

Acute coronary syndromes (STEMI, NSTEMI, Unstable Angina) alongside Aspirin

Authority requiredPBSANTIPLATELETBrilinta60 mg tablet+2

Max Dose

90 mg BD

Half-life

7 h

Dyspnoea

COMMON

Bleeding Risk

HIGH

Rapid Summary

Overview

Highly potent, *reversible* P2Y12 ADP receptor antagonist. Faster and stronger than Clopidogrel, but carries a higher bleeding risk and requires twice-daily dosing.

Maximum Dose

Max 90 mg BD (Maintenance).

Clinical Focus

Unlike Clopidogrel, it is NOT a prodrug. It works instantly and reliably in all genetic profiles.

Bottom Line

Ticagrelor is the preferred P2Y12 inhibitor in ACS with faster onset and superior outcomes to Clopidogrel, but causes dyspnoea and requires twice-daily dosing affecting adherence.

Formulation & Access

Brand Names

Brilinta

Oral Routes

Tablets (60 mg, 90 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Acute coronary syndromes (STEMI, NSTEMI, Unstable Angina) alongside Aspirin.

Clinical Place

Preferred over Clopidogrel for ACS in WA Health due to superior mortality benefit (PLATO trial), provided bleeding risk is acceptable.

Quick reference

Class & Role

Antiplatelet — Highly potent, *reversible* P2Y12 ADP receptor antagonist.

Route / Formulation

Tablets (60 mg, 90 mg). (Brilinta)

Usual Dose & Max

PO 180 mg STAT (Loading dose), then 90 mg BD for 12 months. Max 90 mg BD (Maintenance).

Key Indication Doses

Acute ACS / STEMI: PO 180 mg STAT (Loading dose), then 90 mg BD for 12 months. Extended Prevention: PO 60 mg BD (Can be used beyond 12 months post-MI in high-risk patients).

Best Uses

Ticagrelor is the preferred P2Y12 inhibitor in ACS with faster onset and superior outcomes to Clopidogrel, but causes dyspnoea and requires twice-daily dosing affecting adherence.

Avoid / Cautions

Active bleeding, history of intracranial haemorrhage, severe hepatic impairment. Pregnancy Category B1.

Key Risks

Haematological: Major bleeding (higher risk than Clopidogrel). Respiratory: Dyspnoea (shortness of breath). Very common, usually benign and transient, caused by adenosine accumulation in the lungs. Cardiovascular: Bradycardia, ventricular pauses (usually in the first week of therapy).

Key Interactions

Metabolised by CYP3A4. Strong inhibitors (ketoconazole, clarithromycin) drastically increase bleeding risk. High-dose Aspirin (>150 mg/day) reduces the efficacy of Ticagrelor. Aspirin dose MUST be strictly 100 mg/day.

Monitoring

Monitor for bleeding. Reassure patients who experience mild shortness of breath without hypoxia. Baseline FBC.

Clinical Pearl

Ticagrelor causes a unique sensation of breathlessness in ~15% of patients. If their SpO2, chest auscultation, and CXR are completely normal, this is a benign side effect. Do not blindly treat for APO.

Access

Authority requiredBrilinta60 mg tablet

Brand: Brilinta
PBS status: Authority required
Formulation: Tablets (60 mg, 90 mg)

Ticagrelor

Antiplatelet·Haematology - Antiplatelets

Acute coronary syndromes (STEMI, NSTEMI, Unstable Angina) alongside Aspirin

Authority requiredPBSANTIPLATELETBrilinta60 mg tablet+2

Max Dose

90 mg BD

Half-life

7 h

Dyspnoea

COMMON

Bleeding Risk

HIGH

Rapid Summary

Overview

Highly potent, *reversible* P2Y12 ADP receptor antagonist. Faster and stronger than Clopidogrel, but carries a higher bleeding risk and requires twice-daily dosing.

Maximum Dose

Max 90 mg BD (Maintenance).

Clinical Focus

Unlike Clopidogrel, it is NOT a prodrug. It works instantly and reliably in all genetic profiles.

Bottom Line

Ticagrelor is the preferred P2Y12 inhibitor in ACS with faster onset and superior outcomes to Clopidogrel, but causes dyspnoea and requires twice-daily dosing affecting adherence.

Formulation & Access

Brand Names

Brilinta

Oral Routes

Tablets (60 mg, 90 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Acute coronary syndromes (STEMI, NSTEMI, Unstable Angina) alongside Aspirin.

Clinical Place

Preferred over Clopidogrel for ACS in WA Health due to superior mortality benefit (PLATO trial), provided bleeding risk is acceptable.

Quick reference

Class & Role

Antiplatelet — Highly potent, *reversible* P2Y12 ADP receptor antagonist.

Route / Formulation

Tablets (60 mg, 90 mg). (Brilinta)

Usual Dose & Max

PO 180 mg STAT (Loading dose), then 90 mg BD for 12 months. Max 90 mg BD (Maintenance).

Key Indication Doses

Acute ACS / STEMI: PO 180 mg STAT (Loading dose), then 90 mg BD for 12 months. Extended Prevention: PO 60 mg BD (Can be used beyond 12 months post-MI in high-risk patients).

Best Uses

Ticagrelor is the preferred P2Y12 inhibitor in ACS with faster onset and superior outcomes to Clopidogrel, but causes dyspnoea and requires twice-daily dosing affecting adherence.

Avoid / Cautions

Active bleeding, history of intracranial haemorrhage, severe hepatic impairment. Pregnancy Category B1.

Key Risks

Key Interactions

Monitoring

Monitor for bleeding. Reassure patients who experience mild shortness of breath without hypoxia. Baseline FBC.

Clinical Pearl

Access

Authority requiredBrilinta60 mg tablet

Brand: Brilinta
PBS status: Authority required
Formulation: Tablets (60 mg, 90 mg)