Recommended Dosage of Ticagrelor (Brillinta)
The recommended dosage of Brillinta (ticagrelor) is a loading dose of 180 mg followed by a maintenance dose of 90 mg twice daily. 1, 2, 3
Loading Dose
- Initial loading dose is 180 mg (typically given as two 90 mg tablets at once) 2, 3
- Achieves significant platelet inhibition within 30 minutes of administration 2
- Peak inhibitory effect occurs approximately 2 hours after the loading dose 2
- Loading dose should still be administered when switching from clopidogrel to ticagrelor 2
Maintenance Dose
- 90 mg twice daily (approximately 12 hours apart) for continued therapy 1, 2, 4
- Twice-daily dosing is essential for maintaining consistent platelet inhibition due to ticagrelor's pharmacokinetic profile 4, 3
- When used with aspirin, the recommended aspirin maintenance dose is 81 mg daily 1, 2
Duration of Therapy
- For patients with drug-eluting stents (DES) or bare-metal stents (BMS): continue therapy for at least 1 year 1
- For minor ischemic stroke or high-risk TIA: dual antiplatelet therapy with ticagrelor and aspirin for 30 days 2
- Continuation beyond 1 year may be considered in some patients with DES (Class IIb recommendation) 1
Special Considerations
- Ticagrelor should be avoided in patients with prior history of intracranial hemorrhage 5, 2
- Use with caution in patients with prior stroke or TIA due to increased risk of intracranial bleeding 2
- For patients who experience a cerebrovascular event while on ticagrelor, switching to clopidogrel (75 mg daily) is appropriate 5
- Discontinue ticagrelor at least 5 days before planned surgery 2
- If a dose is missed, the patient should take their next dose at its scheduled time (do not double the dose) 4
Pharmacological Advantages
- Ticagrelor is a direct-acting, reversible P2Y12 receptor antagonist that doesn't require hepatic conversion to an active metabolite 2, 4, 3
- Provides more rapid onset and more consistent inhibition of platelet aggregation compared to clopidogrel 3, 6
- Studies show greater platelet inhibition with ticagrelor compared to clopidogrel in both clopidogrel-experienced and -naïve patients 3, 6
Common Dosing Errors
- If an accidental double dose is taken, skip the next scheduled dose and resume normal twice-daily dosing the following morning 4
- Monitor for signs of bleeding after any dosing errors, particularly in elderly patients (≥75 years) and those with low body weight (<60 kg) 4
- Patient compliance with twice-daily dosing should be reinforced to prevent medication errors 4
Ticagrelor's superior platelet inhibition compared to clopidogrel has been demonstrated in clinical trials, showing reduced rates of cardiovascular death, myocardial infarction, and stent thrombosis, though with a slightly increased risk of minor bleeding 3, 7, 6.