What is the typical dosing regimen for Brilinta (ticagrelor)?

Typical Dosing Regimen for Brilinta (Ticagrelor)

The typical dosing regimen for Brilinta (ticagrelor) is a loading dose of 180 mg followed by a maintenance dose of 90 mg twice daily, with a recommended low-dose aspirin of 81 mg daily as concomitant therapy. 1

Dosing Details by Clinical Scenario

Acute Coronary Syndrome (ACS) - Both NSTEMI and STEMI

1. Initial Loading Dose:

   • 180 mg orally as a one-time dose 1
   • Should be administered as soon as possible after presentation or at the time of PCI

2. Maintenance Dose:

   • 90 mg orally twice daily 1
   • Duration: Typically continued for 12 months after ACS event 1

3. Concomitant Aspirin:

   • Critical point: The recommended maintenance dose of aspirin to be used with ticagrelor is specifically 81 mg daily 1, 2
   • Higher aspirin doses (>100 mg daily) may reduce ticagrelor's effectiveness 3

Special Administration Considerations

• Patients unable to swallow tablets: Ticagrelor tablets can be crushed and prepared for oral administration or for administration via a nasogastric tube with >97% of the dose delivered 4
• Timing before surgery: Discontinue ticagrelor at least 5 days before planned surgery to reduce bleeding risk 1

Extended Therapy Options

For high-risk patients with history of MI requiring extended therapy beyond 1 year:

• Reduced maintenance dose of 60 mg twice daily may be used for long-term secondary prevention 5
• Should still be coadministered with low-dose aspirin (75-150 mg/day) 5

Important Clinical Considerations

Contraindications and Cautions

• History of intracranial hemorrhage
• Active pathological bleeding
• Severe hepatic impairment
• Concomitant use with strong CYP3A inhibitors or inducers

Common Side Effects to Monitor

• Dyspnea (occurs in up to 15% of patients, usually within first week of treatment) 1
• Increased risk of non-CABG related bleeding compared to clopidogrel 1
• Bradycardia 1

Clinical Pearls

1. Patient compliance is especially important with the twice-daily dosing regimen 1
2. Unlike clopidogrel and prasugrel, ticagrelor is a direct-acting P2Y12 inhibitor that does not require metabolic activation 6
3. The 81 mg aspirin dose with ticagrelor is critical - higher aspirin doses may reduce ticagrelor's effectiveness based on post-hoc analysis of the PLATO trial 1
4. For patients transitioning from clopidogrel to ticagrelor, a loading dose of ticagrelor should still be administered 1

By following this dosing regimen, you can optimize the mortality and morbidity benefits of ticagrelor therapy while minimizing bleeding risks in patients with acute coronary syndromes.