What if I miss a dose of ticagrelor (Brillinta) after a stroke?

Management of Missed Ticagrelor (Brilinta) Dose After Stroke

If you miss a dose of ticagrelor after a stroke, take it as soon as you remember if within 12 hours of the scheduled time; otherwise, skip the missed dose and take your next regularly scheduled dose without doubling up. 1

Understanding the Risks of Missing Doses

Missing doses of ticagrelor after stroke is concerning because:

• Reduced platelet inhibition occurs 8-12 hours after the last dose, significantly increasing thrombotic risk 1
• The risk of thrombotic events is highest during the first 30 days after stroke 1
• Ticagrelor's twice-daily dosing regimen makes adherence particularly important 2, 1

Specific Instructions for Missed Doses

Follow this algorithm when missing a dose:

1. If remembered within 12 hours of scheduled time:

   • Take the missed dose immediately
   • Resume your regular twice-daily schedule
   • Do not double the next dose

2. If more than 12 hours have passed:

   • Skip the missed dose entirely
   • Take the next dose at the regularly scheduled time
   • Do not attempt to "catch up" by doubling doses 1

Warning Signs to Monitor

After missing a dose, be vigilant for:

• Chest pain
• Shortness of breath
• Neurological symptoms (similar to those experienced during initial stroke)
• Any new or worsening symptoms

If any of these occur, seek immediate medical attention 1

Important Considerations for Stroke Patients

• Ticagrelor increases the risk of intracranial hemorrhage compared to clopidogrel in patients with prior stroke or TIA 2, 1
• The period of withdrawal before any planned surgery should be at least 5 days 2
• The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily 2

Adherence Strategies

To minimize missed doses:

• Set medication reminders on your phone or use a pill organizer
• Take medication at the same times each day
• Keep a backup supply of medication at work or when traveling
• Develop a routine that incorporates taking medication with daily activities

Pitfalls to Avoid

• Never double-dose to make up for a missed dose
• Don't discontinue ticagrelor without consulting your healthcare provider
• Don't confuse dyspnea (shortness of breath), which can be a side effect of ticagrelor, with stroke symptoms 3
• Don't switch between antiplatelet medications without medical guidance

Regular adherence to ticagrelor therapy is crucial for stroke prevention, as demonstrated by multiple clinical trials showing its efficacy in reducing recurrent stroke risk when properly taken 4, 5, 6.