Description

Brilinta 90 mg (Ticagrelor) – Maintenance Dose for Up to 12 Months After ACS

Brilinta 90 mg is the twice-daily maintenance tablet taken after an initial 180 mg loading dose of ticagrelor. It’s administered with low-dose aspirin to reduce the risk of cardiovascular death, recurrent myocardial infarction, and stroke in patients with acute coronary syndrome (ACS) or history of MI, during the first 12 months post‑event.

Key Benefits:

• Proven reduction in major cardiac events during maintenance period post‑ACS
• Superior to clopidogrel in reducing CV death, MI, and stroke in PLATO and subsequent trials 
• Predictable pharmacokinetics with reversible P2Y₁₂ receptor inhibition

How It Works

Ticagrelor reversibly inhibits the P2Y₁₂ platelet receptor, preventing ADP-mediated aggregation. It does not require metabolic activation and acts rapidly to reduce thrombotic risk.

Recommended Dosage

• Initiate with a single 180 mg loading dose
• Follow with 90 mg twice daily, starting 6–12 hours after the loading dose
• Continue for up to 12 months post‑ACS, then consider reducing to 60 mg twice daily for long-term maintenance if appropriate. Aspirin 75–100 mg once daily is mandatory for DAPT. 

Possible Side Effects

• Bleeding (including gastrointestinal and intracranial)—significant but outweighed by CV benefits 
• Dyspnea, usually mild and self-limiting (~14–21%) 
• Rare: bradyarrhythmias, elevated uric acid, rash 

Precautions & Interactions

• Use with low-dose aspirin only (≤100 mg)—higher aspirin doses reduce effectiveness.
• Contraindicated in active bleeding or history of intracranial hemorrhage, severe hepatic impairment, or hypersensitivity 
• Avoid CYP3A4 inhibitors (e.g., ketoconazole, grapefruit juice) and inducers (e.g., rifampin)—may alter drug levels and bleeding risk.
• Caution with other anticoagulants or antiplatelets due to increased bleeding risk
• Monitor heart rate and respiratory symptoms; pause before major surgery if possible 

Frequently Asked Questions (FAQs)

1. What is Brilinta 90 mg used for?

Used for maintenance antiplatelet therapy during the first year after ACS or MI to reduce the risk of recurrent events. 

2. How long should 90 mg dosing continue?

Up to 12 months post‑ACS, followed by potential transition to 60 mg twice daily for long-term therapy. 

3. What if a dose is missed?

Skip the missed dose and resume the regular dosing schedule. Do not double-dose. 

4. Can patients swallow tablets whole?

Yes—tablets may also be crushed and mixed with water or given via a nasogastric tube if needed. 

5. Can aspirin dose exceed 100 mg?

No—aspirin above 100 mg daily decreases ticagrelor effectiveness and increases bleeding risk.