Antiplatelet Pregnancy: Avoid — limited data, theoretical risk of fetal harm

Ticagrelor

Brand names: Brilique

Adult dose

Dose: Loading: 180 mg once, then 90 mg twice daily

Route: Oral

Frequency: Loading dose then BD

Max: 180 mg loading; 90 mg BD maintenance

PLATO trial. Do not use with dose of aspirin >100 mg/day. Discontinue 5 days before elective surgery.

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

Not recommended in paediatric patients

Dose adjustments

Renal

No dose adjustment required. Caution in severe renal impairment.

Hepatic

Avoid in severe hepatic impairment. Caution in moderate impairment.

Clinical pearls

Reversible P2Y12 inhibitor — no prodrug activation needed, faster onset than clopidogrel
Dyspnoea usually mild, self-limiting; does not reflect cardiac cause
Superior to clopidogrel in PLATO trial for ACS outcomes
Preferred over clopidogrel in NSTEMI/STEMI per ESC guidelines

Contraindications

Active pathological bleeding
History of intracranial haemorrhage
Severe hepatic impairment
Concomitant strong CYP3A4 inhibitors

Side effects

Dyspnoea (15%)
Bleeding
Bradycardia
Dyspepsia
Ventricular pauses (usually asymptomatic)

Interactions

Aspirin >100 mg/day (avoid)
Strong CYP3A4 inhibitors — ketoconazole/clarithromycin (avoid)
Simvastatin/lovastatin — limit to 40 mg/day
Digoxin — monitor levels

Monitoring

Signs of bleeding
Renal function
LFTs in hepatic disease
Dyspnoea symptoms

Reference: BNFc; PLATO Trial (Wallentin et al, NEJM 2009); ESC ACS Guidelines 2023; BNF. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways