Brilique tablets contain the active ingredient ticagrelor, which is a type of medicine called an antiplatelet.
What is it used for?
- Reducing the risk of atherothrombotic events (eg heart attack, stroke, further heart attacks or death) in people who have had a heart attack, or are having severe chest pain caused by unstable angina.
- Brilique tablets are given in combination with low dose aspirin (75mg to 150mg daily dose), unless aspirin is unsuitable.
How does it work?
- Brilique tablets contain the active ingredient ticagrelor, which is a type of medicine called an antiplatelet (sometimes referred to as a 'blood-thinning' medicine).
- Ticagrelor works by preventing the action of a natural substance called adenosine diphosphate (ADP). ADP is one of the chemicals in the body that cause platelets to clump together and start the process of blood clotting. Ticagrelor binds to a specific area on the platelets known as the P2Y12 receptors.
How do I take it?
- Brilique tablets are usually taken twice a day. They can be taken either with or without food.
- You should not stop taking this medicine until your doctor tells you to. If you stop taking Brilique too soon, this may increase your chances of having another heart attack or stroke.
Use with caution in
- People at increased risk of bleeding, for example due to recent surgery or injury, or problems with blood clotting.
- People who have recently had bleeding in the gut, for example from a peptic ulcer.
- People taking other medicines that increase the risk of bleeding (see end of factsheet for examples).
- A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome).
- People with a serious defect in the heart's electrical message pathways, resulting in decreased function of the heart (2nd or 3rd degree heart block).
- People who experience fainting related to a slow heart rate.
- People with a history of asthma.
- People with a history of chronic obstructive lung disease (COPD).
- Moderate to severely decreased kidney function.
- History of raised uric acid levels in the blood.
- History of gout.
Not to be used in
- People with any active bleeding, for example from a peptic ulcer or brain haemorrhage.
- People who have recently had bleeding inside the skull (intracranial haemorrhage).
- Moderate to severely decreased liver function.
- People taking the antifungal ketoconazole, the antibiotic clarithromycin, ritonavir or atazanavir for HIV infection, or the antidepressant nefazodone.
- This medicine is not recommended for people having kidney dialysis, or people with kidney problems caused by raised levels of uric acid in the urine.
- The safety and efficacy of this medicine in children and adolescents under 18 years of age has not been established. It is not recommended for this age group.
- This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- There is no information available about the safety of this medicine for use during pregnancy. The manufacturer states that it is not recommended for use during pregnancy and that contraception should be used to avoid pregnancy while taking this medicine. Seek further medical advice from your doctor.
- It is not known if this medicine passes into breast milk. The manufacturer states that it should not be used during breastfeeding. Mothers who need to take this medicine should not breastfeed. Seek further medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Bleeding at injection sites.
- Bleeding in the stomach or bowels.
- Shortness of breath.
- Disturbances of the gut such as abdominal pain, nausea, vomiting, diarrhoea, indigestion.
- Inflammation of the stomach (gastritis).
- Bleeding gums.
- Bleeding inside the skull or brain.
- Bleeding in the eyes.
- Coughing up or vomiting blood.
- Blood in the urine.
- Vaginal bleeding.
- Rash or itching.
- Pins and needles sensations (paraesthesia).
- Increased blood uric acid level (hyperuricaemia).
- Sensation of spinning (vertigo).
- Bleeding from the ear.
- Elevated levels of creatinine in the blood.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
The medicines listed below increase the blood level of ticagrelor, which could increase the risk of its side effects. These medicines should not be taken in combination with ticagrelor:
The medicines listed below may also increase the blood level of ticagrelor, but to a lesser extent than those listed above. They should be used with caution in combination with ticagrelor:
The medicines listed below may decrease the blood level of ticagrelor, which could make it less effective. These medicines should be avoided where possible while you are taking ticagrelor:
There may be an increased risk of bleeding if ticagrelor is taken in combination with the following medicines, which also affect blood clotting:
- glycoprotein IIb/IIIa inhibitors, eg abciximab, eptifibatide, tirofiban
- low molecular weight heparin, eg dalteparin
- medicines that break down blood clots (thrombolytics), eg alteplase, streptokinase
- non-steroidal anti-inflammatory drugs (NSAIDs), eg naproxen, ibuprofen, diclofenac
- oral anticoagulants such as warfarin
- SSRI antidepressants, eg fluoxetine, paroxetine, citalopram
If you are taking any of the medicines listed above you should be carefully monitored for any signs of bleeding during the first weeks of treatment with ticagrelor, and following any surgery.
If ticagrelor is taken with any of the following medicines it may increase the amount of these medicines in the blood:
- cisapride (not recommended in combination with ticagrelor)
- ergot alkaloids, such as ergotamine or methsergide (not recommended in combination with ticagrelor)
- lovastatin (no more than a 40mg daily dose of lovastatin should be used in combination with ticagrelor)
- simvastatin (no more than a 40mg daily dose of simvastatin should be used in combination with ticagrelor).
There may be an increased risk of a slow heart rate if this medicine is taken with the following medicines:
- anti-arrhythmics medicines such as amiodarone, disopyramide, quinidine
- beta-blockers such as atenolol, bisoprolol, propranolol
- calcium-channel blockers such as verapamil, nifedipine