What are the side effects of Brilinta?

Medically reviewed by Dr. Jamie Winn
Aug 9, 2023

Brilinta (ticagrelor) is a brand-name medication manufactured by AstraZeneca. It is considered an antiplatelet drug that is used to reduce your risk of a stroke and heart attack. Brilinta is typically well tolerated when taken as directed by your healthcare provider. However, there are some possible side effects that you should be aware of. This medication's most common side effects include shortness of breath and an increased risk of bleeding. Brilinta can rarely cause serious and sometimes fatal bleeding that may need immediate medical attention.

Keep reading as we discuss how Brilinta works and some of the other side effects you should be aware of.

What is Brilinta?

Brilinta (ticagrelor) is a platelet inhibitor approved by the U.S. Food and Drug Administration (FDA) to lower your risk of stroke, myocardial infarction (heart attack), and death with acute coronary syndrome (ACS), unstable angina (severe chest pain), or in people who have had a heart attack before. It can be used to lower your risk of thrombosis (blood clots) after having a stent placed in the blood vessels in your heart. Brilinta is also approved to lower your risk of a first stroke or heart attack from coronary artery disease (CAD) or certain conditions such as acute ischemic stroke or high-risk transient ischemic attack (TIA).

How does Brilinta work?

The active ingredient in Brilinta, ticagrelor is a type of antiplatelet medication. Platelets are a certain type of blood cell that stick together to form blood clots. Ticagrelor helps stop your platelets from clumping together, which increases blood flow to your heart. This can lower your risk of serious events, including a heart attack or stroke.

What are the most common side effects of Brilinta?

The most common side effects of Brilinta include:

Shortness of breath
Minor bleeding including nosebleeds
Nausea
Diarrhea
Slow heart rate (bradycardia)
Dizziness

Brilinta can rarely cause serious side effects, including:

Serious, life-threatening allergic reactions, including anaphylaxis (hives, swelling of your tongue or throat, and shortness of breath)
Increased risk of serious bleeding, especially if you take Brilinta with other blood thinners or anticoagulants
Severe liver problems

These are not all of the possible side effects of Brilinta. You should always seek medical advice from your healthcare professional for any questions or concerns about your medical condition or treatment. Read all medication guides or drug information sheets that come with this medication. You can report side effects to FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Are there any drug interactions with Brilinta?

When Brilinta is taken with other drugs, it can change how Brilinta works or make some side effects more likely or severe. You should ask your healthcare provider if any of the prescription drugs, over-the-counter (OTC) drugs, vitamins, or supplements you take may interact with Brilinta, including:

Lovastatin, simvastatin, and other cholesterol medications
Ketoconazole, itraconazole, and certain other antifungals
Phenytoin, carbamazepine, phenobarbital, and certain other seizure medications
Protease inhibitors such as ritonavir and atazanavir, which are used to treat HIV
Antibiotics such as clarithromycin
Warfarin
Clopidogrel
Digoxin
Nefazodone
Naproxen
Ibuprofen
Rifampin

What boxed warnings and precautions are there with Brilinta?

Brilinta carries a boxed warning outlining its bleeding risks:

Brilinta can cause serious and sometimes fatal bleeding. You should avoid this medication if you are actively bleeding or have a history of intracranial (inside your skull) bleeding.
You should not start taking Brilinta if you are having coronary artery bypass graft (CABG) surgery.
You should not stop this medication unless absolutely necessary if you have a bleeding episode. Stopping Brilinta can raise the risk of serious cardiovascular complications such as stroke and heart attack.
Do not take a dose of aspirin that is over 100 mg per day as it may reduce the effectiveness of Brilinta.

There are also other precautions your doctor may need to take if you have certain medical conditions, including:

Active bleeding or signs of severe bleeding such as black or tarry stools, red, pink, or brown urine, or coughing up blood or vomit that looks like coffee grounds
Lung problems, including COPD or asthma as Brilinta may make worsen these conditions
Heart disease, heart rhythm problems, or high blood pressure
Liver disease
Taking more than 100 mg of aspirin a day
Are pregnant or plan on becoming pregnant
Are breastfeeding or plan on breastfeeding as it is unknown if this drug passes into breast milk

What foods should you avoid while taking Brilinta?

You can take Brilinta with or without food. However, the one food you should avoid while taking Brilinta is grapefruit juice. Grapefruit juice can block a certain liver enzyme (CYP3A4) that is needed to break down Brilinta for your body to get rid of it. This may increase the antiplatelet effect of Brilinta and increase your risk of bleeding.

What is the maximum dose of Brilinta?

The maximum dose of Brilinta will depend on several factors such as the condition being treated, other medications you are taking, and your response to treatment.

For a history of ACS or myocardial infarction (heart attack), you start with a loading dose of Brilinta 180 mg and then will take a 90 mg tablet of Brilinta twice daily for the first year. After the first year, you will take Brilinta 60 mg twice daily thereafter.

For CAD with no previous stroke or heart attack, you take 60 mg of Brilinta twice daily.

For an ischemic stroke, you start with a loading dose of Brilinta 180 mg. Then you will take 90 mg of Brilinta twice daily for up to 30 days.

You should always use Brilinta with 75 mg-100 mg per day of aspirin along with Brilinta.

Why does Brilinta cause shortness of breath?

Taking Brilinta may cause an abnormally slow heart rate (bradycardia). You should use Brilinta with caution if you already have heart rate issues, as it may make them worse. A slow heart rate can cause serious problems such as shortness of breath, dizziness, and fainting. It is not fully understood what causes this problem but some experts think it could be due to an increased level of adenosine or the blocking of P2Y12 receptors that are found on platelets and other cells in your central nervous system.

While shortness of breath is a common side effect of Brilinta, the episodes are typically mild and disappear within a few days, with no need to stop this medication. However, if you are having trouble breathing, call your healthcare provider to see if a change in medication is necessary.

Is it safe to take Brilinta with aspirin?

Brilinta is typically taken with a maintenance dose of aspirin to help prevent the formation of blood clots. This is called dual antiplatelet therapy. Be sure to take these 2 medications exactly as instructed by your doctor. Do not stop taking Brilinta or aspirin unless your doctor tells you to as it can increase your risk of heart attack, stroke, or death. You typically will not take more than 100 mg a day of aspirin because higher doses can affect how well Brilinta works. Make sure your doctor is aware of any medications you take that contain aspirin.