Ticagrelor Tablet: Uses, Dosage & Side Effects in Pakistan

Ticagrelor (Brilinta) Tablet Uses, Dosage, Side Effects & Price in Pakistan

1. Quick Info (Mukhtasir Maloomat)

2. What is Ticagrelor? (Ticagrelor kya hai)

Ticagrelor (Brilinta) is an antiplatelet medicine that prevents platelets from aggregating in the blood — that is, it prevents blood clots. It directly and reversibly blocks the P2Y12 ADP receptor.

After ACS, or after coronary stent placement, ticagrelor is given with aspirin in DAPT (Dual Antiplatelet Therapy). During the first year after stenting, this combination protects against stent thrombosis and recurrent heart attack.

CRITICAL WARNING: Ticagrelor must NEVER be stopped abruptly after ACS or stent placement — acute stent thrombosis (potentially fatal MI) can occur. Missing doses or self-discontinuing is very dangerous.

3. Uses (Fayde / Kis kaam aata hai)

• Acute Coronary Syndrome (ACS) — DAPT with aspirin in heart attack (NSTEMI/STEMI) or unstable angina
• Post-PCI — stent thrombosis prevention after coronary stent placement
• Established CAD at high risk — 60mg dosing (PEGASUS-TIMI 54 trial — patients >1 year post-MI)
• Peripheral Arterial Disease (PAD) — with aspirin

4. Who Should Take (Kis ko lena chahiye)

• After ACS (heart attack / unstable angina) — with cardiologist's prescription
• After coronary stent (PCI) — in DAPT with aspirin
• High-risk CAD patients for whom a cardiologist has recommended 60mg dosing
• Patients with PAD (peripheral arterial disease) — with aspirin

5. When NOT to Take (Kab nahi lena chahiye)

• Prior intracranial haemorrhage (brain bleeding) — CONTRAINDICATED
• Active pathological bleeding
• Severe hepatic impairment (avoid)
• With strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin) — avoid
• With aspirin >100mg/day

6. Dosage (Kitni leni hai)

• 90 mg twice daily
• An initial loading dose of 180mg is usually given by the cardiologist

• 60 mg twice daily

• 90 mg BD (ACS) or 60 mg BD (chronic) — do not adjust dose yourself

• If a dose is missed, take it as soon as remembered. Do not double the dose. For ACS/stent patients — missing a dose is risky; inform your cardiologist.

7. How to Take (Kaise lena hai)

• Tablet may be taken with or without food
• Take at the same time every day
• Take aspirin at 75–100mg only — no more
• Inform your doctor 5 days before any surgical procedure

8. Best Time (Kab lena chahiye)

• Every morning and evening — at the same times (BD dosing)
• With or without food — with food if GI issues occur

9. Empty Stomach or After Food

Ticagrelor may be taken with or without food. Taking it with food is preferable if stomach upset occurs.

10. Warnings (Ihtiyat)

• Within the first year after ACS or stent placement — abrupt discontinuation leads to acute stent thrombosis → fatal MI

• Aspirin at 75–100mg/day only — higher doses reduce ticagrelor efficacy

• Discontinue 5 days before elective surgery

• Prior intracranial haemorrhage — CONTRAINDICATED

11. Precautions (Ahm ehtiyaat)

• Monitor for bleeding signs — unusual bruising, nosebleeds, black stools
• Breathlessness (dyspnoea) — reassure: this is an adenosine effect, not bronchospasm. Usually resolves on its own. If severe, consult a cardiologist.
• Store the medicine in a cool place — out of reach of children

12. Side Effects (Nuksanat)

• Bleeding (bruising, nosebleed, GI bleeding)
• Dyspnoea / breathlessness (15-20% patients — characteristic ticagrelor side effect; NOT bronchospasm)
• Headache, dizziness, nausea
• Hyperuricaemia (mild — usually asymptomatic)

• Major bleeding (intracranial, fatal GI bleeding)
• Ventricular pauses (usually short/asymptomatic)
• Severe dyspnoea (rare — cardiologist review)

13. Drug Interactions (Dawaon ke saath reaction)

• Aspirin >100mg/day — ticagrelor efficacy is REDUCED (CRITICAL — use only 75–100mg aspirin)
• Strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) — ticagrelor levels increase → bleeding risk (avoid)
• Strong CYP3A4 inducers (rifampicin, carbamazepine, phenytoin) — ticagrelor levels REDUCE → treatment failure (AVOID)
• Simvastatin / lovastatin — ticagrelor raises levels of these statins via CYP3A4 → myopathy risk
• Digoxin — ticagrelor's modest P-gp inhibition raises digoxin levels → monitor for toxicity
• Anticoagulants (warfarin, heparin) — additive bleeding risk

14. When to See Doctor (Kab doctor ke paas jayein)

• Excessive or unusual bleeding
• Severe or worsening breathlessness (cardiologist review)
• Severe bradycardia or fainting
• Sudden severe chest pain — stent thrombosis
• Black or tarry stools (GI bleeding)

15. Alternatives (Sasti Dusri Dawaein)

16. Price in Pakistan (Price kitni hai)

17. FAQs (Aksar poochay jane walay sawalat)

Q: Ticagrelor kis kaam aata hai?

A: Ticagrelor (Brilinta) is an antiplatelet medicine that prevents blood clots after ACS (heart attack/unstable angina) and stent placement. It is used with aspirin in DAPT.

Q: Ticagrelor se sans phoolna kyun hota hai?

A: Ticagrelor causes breathlessness (dyspnoea) through adenosine accumulation — it is not bronchospasm or an asthma attack. It occurs in 15–20% of patients and usually resolves on its own. If severe, consult a cardiologist.

Q: Ticagrelor band karna dangerous kyun hai?

A: Within the first year after ACS or stent placement — abrupt discontinuation causes acute stent thrombosis, which can result in a fatal heart attack. NEVER discontinue without the doctor's explicit permission.

Q: Ticagrelor price in Pakistan kya hai?

A: Brilinta (AstraZeneca) is an imported brand — price varies by pharmacy and pack size. Confirm the exact price with your local pharmacy or a licensed online pharmacy.

Q: Ticagrelor clopidogrel se kaise alag hai?

A: Ticagrelor is a reversible P2Y12 antagonist — faster, more potent, no CYP2C19 dependence (no non-responder problem). Clopidogrel is a prodrug — activated by CYP2C19; more widely available and cheaper in Pakistan. The cardiologist decides which is more appropriate.

18. Medical Review (Medical jaiza)

Compiled by the PakVita Editorial Team · AI-assisted drafting with editorial review · Sourced from DRAP, WHO, BNF · Last updated: 2026-06-17

19. Disclaimer (Zaroori tanbeeh)

The information on this page is for awareness only. It is not medical advice. Always consult your doctor or pharmacist before taking any medicine. PakVita is not responsible for any harm.