Antiplatelet Pregnancy: Not recommended during pregnancy — there are no or limited data in pregnant women and animal studies have shown reproductive toxicity. Women of childbearing potential should use appropriate contraceptive measures to avoid pregnancy during ticagrelor therapy. Ticagrelor and its active metabolites are excreted in milk in animals and a risk to newborns/infants cannot be excluded.

Ticagrelor

Brand names: Brilique

Used in: Acute Coronary Syndrome & Chest Pain

Ticagrelor is an antiplatelet (P2Y12 inhibitor) used with aspirin after acute coronary syndromes.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Acute coronary syndromes: single 180 mg loading dose (two 90 mg tablets), then 90 mg

Route: Oral

Frequency: Loading dose once, then 90 mg twice daily

Patients taking ticagrelor should also take a daily low maintenance dose of aspirin 75-150 mg, unless specifically contraindicated. ACS: 90 mg twice daily is recommended for 12 months unless discontinuation is clinically indicated. Discontinuation of aspirin may be considered after 3 months in ACS patients who have undergone PCI and have an increased risk of bleeding; in that case ticagrelor as single antiplatelet therapy should be continued for 9 months. History of myocardial infarction (extended treatment): 60 mg twice daily is the recommended dose for patients with a history of MI of at least one year and a high risk of an atherothrombotic event; treatment may be started without interruption as continuation therapy after the initial one-year treatment with ticagrelor 90 mg or other ADP receptor inhibitor, or initiated up to 2 years from the MI or within one year after stopping previous ADP receptor inhibitor treatment. There are limited data beyond 3 years of extended treatment. If a switch is needed, the first ticagrelor dose should be given 24 hours after the last dose of the other antiplatelet medicine. Missed dose: take only one tablet (the next dose) at its scheduled time. Method of administration: oral, with or without food; tablets may be crushed to a fine powder and mixed in half a glass of water and drunk immediately (rinse the glass with a further half glass of water and drink), and the mixture may be given via a nasogastric tube CH8 or greater, flushing the tube with water afterwards. Elderly: no dose adjustment required. Hepatic impairment: contraindicated in severe impairment; only limited information in moderate impairment where dose adjustment is not recommended but caution is advised; no adjustment in mild impairment. Paediatric: safety and efficacy in children below 18 years have not been established; there is no relevant use in children with sickle cell disease. Surgery (section 4.4): if elective surgery is planned and antiplatelet effect is not desired, discontinue ticagrelor 5 days prior to surgery. SPC section 4.5 (interactions) was not captured in the fetched bundle — clinician to review; note section 4.3 contraindicates strong CYP3A4 inhibitors.

Dose adjustments

Renal

No dose adjustment is necessary for patients with renal impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

ACS or History of MI Initiate treatment with 180 mg oral loading dose of ticagrelor tablets. Then administer 90 mg twice daily during the first year. After one year, administer 60 mg twice daily. ( 2.2 ) Patients with CAD and No Prior Stroke or MI Administer 60 mg ticagrelor tablets twice daily. ( 2.3 ) Acute Ischemic Stroke Initiate treatment with a 180 mg loading dose of ticagrelor tablets then continue with 90 mg twice daily for up to 30 days. ( 2.4 ) Use ticagrelor tablets with a daily maintenance dose of aspirin of 75 to 100 mg. ( 2 ) However, in patients who have undergone PCI, consider single antiplatelet therapy with ticagrelor tablets based on the evolving risk for thrombotic …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-10-28. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Active pathological bleeding
History of intracranial haemorrhage
Severe hepatic impairment
Co-administration with strong CYP3A4 inhibitors (e.g. ketoconazole, clarithromycin, nefazodone, ritonavir, atazanavir), which may substantially increase ticagrelor exposure

Side effects

Bleeding — the most commonly reported adverse reaction, including gastrointestinal haemorrhage, subcutaneous or dermal bleeding, respiratory, urinary tract, muscular, eye, ear and reproductive system bleedings, post-procedural haemorrhage and traumatic bleedings
Dyspnoea (common)
Dizziness, syncope, headache (common)
Hyperuricaemia and blood creatinine increased (common, derived from laboratory observations); gout/gouty arthritis
Gastrointestinal: diarrhoea, nausea, dyspepsia, constipation (common); rash and pruritus
Intracranial haemorrhage (frequency not known); bradyarrhythmia and AV block, thrombotic thrombocytopenic purpura and hypersensitivity including angioedema (identified post-marketing)

Clinical monograph

How it works

It reversibly inhibits the platelet P2Y12 receptor and, unlike clopidogrel, is not a pro-drug — giving a faster, more consistent effect.

Prescribing in practice

Dyspnoea is a characteristic and usually benign side effect, but should be assessed.
Keep concurrent aspirin low-dose — higher aspirin doses reduce its benefit; it is taken twice daily.
It can cause bradyarrhythmias and ventricular pauses; bleeding risk; it interacts with strong CYP3A inhibitors/inducers.

Monitoring

Watch for bleeding and breathlessness; reinforce adherence to twice-daily dosing.

Counselling the patient

Take it twice a day, and keep to low-dose aspirin.
Breathlessness can occur and often settles — but report it.
Report bleeding; don't stop it without advice.

Evidence & guidelines

Reduced cardiovascular events versus clopidogrel after ACS (PLATO; NICE TA236).

Reference: PLATO Trial (Wallentin et al, NEJM 2009); ESC ACS Guidelines 2023; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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