What is the usual adult dose of Brilinta (ticagrelor)?

Brilinta (Ticagrelor) Usual Dose

For acute coronary syndrome, give a 180 mg loading dose immediately, followed by 90 mg twice daily for 12 months. 1

Standard Dosing Regimen for Acute Coronary Syndrome

Loading dose:

• 180 mg orally as soon as ACS is diagnosed, before any invasive procedure 2, 1
• Platelet inhibition is achieved within approximately 30 minutes 3
• Administer the first maintenance dose 6-12 hours after the loading dose 1

Maintenance dose:

• 90 mg twice daily for the first 12 months after an ACS event 2, 1
• After one year, may reduce to 60 mg twice daily for extended therapy in high-risk patients 1, 3

Concomitant aspirin:

• 75-100 mg daily (81 mg in the United States) 2, 1
• Never exceed 100 mg daily – higher aspirin doses diminish ticagrelor's antiplatelet efficacy (FDA black-box warning) 1, 3

Dosing for Stable Coronary Artery Disease (No Recent MI)

• 60 mg twice daily with aspirin 75-100 mg daily 1
• No loading dose required in this population 1

Dosing for Acute Ischemic Stroke or TIA

• 180 mg loading dose, then 90 mg twice daily for up to 30 days 1
• Use with aspirin loading dose 300-325 mg, then 75-100 mg daily maintenance 1

Special Population Adjustments

No dose adjustment required for:

• Elderly patients (≥75 years) – standard 90 mg twice daily 3
• Low body weight (≤60 kg) – unlike prasugrel, ticagrelor requires no reduction 3
• Moderate renal impairment (CKD stage ≥3b) – standard dosing appropriate 3
• End-stage renal disease on hemodialysis – standard dosing, drug is not dialyzable 1

Critical Administration Details

Tablet administration:

• Can be taken with or without food 1
• For patients unable to swallow: crush tablets, mix with water, and administer orally or via nasogastric tube (≥CH8) 1
• If a dose is missed, take the next dose at its scheduled time – do not double 1

Do not co-administer:

• With another oral P2Y12 inhibitor 1
• With aspirin doses >100 mg daily 1

Duration of Therapy

• 12 months minimum for all ACS patients without high bleeding risk 2, 3
• High bleeding risk patients (PRECISE-DAPT score ≥25): may shorten to 6 months 3
• Extended therapy beyond 12 months: reduce to 60 mg twice daily 1, 3

Common Pitfalls to Avoid

• Never delay the loading dose – administer immediately upon ACS diagnosis 3
• Never use high-dose aspirin (>100 mg) with ticagrelor – this blunts antiplatelet effect 1, 3
• Never discontinue within first 30 days after stent placement – markedly increases stent thrombosis risk 3
• Never assume dose adjustments are needed for age, weight, or renal function – standard dosing applies 3