Brilinta

Before taking ticagrelor,

• tell your doctor and pharmacist if you are allergic to ticagrelor, any other medications, or any of the ingredients in ticagrelor tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: antibiotics such as clarithromycin (Biaxin, in PrevPak) and telithromycin (Ketek); antifungal medications such as itraconazole (Onmel, Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); cholesterol-lowering medications such as lovastatin (Altoprev, in Advicor) and simvastatin (Zocor, in Simcor, in Vytorin); digoxin (Lanoxin); medications for high blood pressure; medications for human immunodeficiency virus (HIV) such as atazanavir (Reyataz, in Evotaz), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra, in Viekira Pak), and saquinavir (Invirase);medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol, others), phenobarbital, and phenytoin (Dilantin); nefazodone; and rifampin (Rifadin, Rimactane, in Rifamate, in Rifater). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had any type of lung disease such as chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways) or asthma.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking ticagrelor, call your doctor.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Brilinta is a prescription medicine used, with aspirin, to prevent heart attacks and strokes in adults. Brilinta is used to prevent blood clots and is for people who:

• have had a recent heart attack or severe chest pain that happened because their heart was not getting enough oxygen.
• have had a heart attack or chest pain and are being treated with medicines or with a procedure to open blocked arteries in the heart.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

• Astrazeneca

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Brilinta falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Take Brilinta exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

• The recommended loading dose of Brilinta after an acute coronary syndrome (ACS) event is 180 mg (two 90 mg tablets).
• Following the loading dose, the recommended Brilinta dose is 90 mg twice daily for the first year after an ACS event. 
• After one year, Brilinta 60 mg twice daily is recommended. 
• After the initial loading dose of aspirin (usually 325 mg), use Brilinta with a daily maintenance dose of aspirin of 75-100 mg.

Your doctor will determine how long you should continue to take Brilinta.

• Nonthienopyridine P2Y12 platelet ADP-receptor antagonist; unlike thienopyridines (e.g., clopidogrel, prasugrel), ticagrelor binds reversibly to P2Y12 receptor and does not require hepatic transformation to exerts its pharmacologic effect.1 2 3 7 13 16 18 25 27 41 42

• Prevents signal transduction of the cyclic adenosine monophosphate (cAMP) pathway, resulting in reduced exposure of fibrinogen binding sites to the platelet glycoprotein (GP IIb/IIIa) complex and subsequent inhibition of platelet activation and aggregation.1 13

• Inhibits reuptake of adenosine into erythrocytes.10 11 12 13 14 16

• Compared with clopidogrel, ticagrelor produces more rapid and effective inhibition of platelet aggregation and has a faster offset of action.1 2 7 18 19 26 27 28 30 36 However, relationship between inhibition of platelet aggregation and clinical outcomes of either drug not known.1

• Genetic polymorphism of the CYP2C19 isoenzyme does not appear to affect pharmacodynamic or clinical response to ticagrelor.1 23 41 47

• Importance of patients taking ticagrelor exactly as prescribed and not discontinuing therapy without first consulting the prescribing clinician.1 Importance of reviewing with clinician how to resume therapy in the event of a missed dose.1 (See Administration under Dosage and Administration.) Importance of patients reading the medication guide prior to initiation of therapy and each time prescription is refilled.1

• Importance of advising patients to check their prescription carefully to ensure that they have received the correct drug; prescribing and dispensing errors have been reported due to similarities in the spelling and pronunciation of Brilinta (the trade name for ticagrelor) and Brintellix (the former trade name for vortioxetine, an antidepressant; trade name changed to Trintellix in May 2016).59 1011 1012 (See Prescribing and Dispensing Precautions under Cautions.)

• Importance of patients informing clinicians (e.g., physicians, dentists) about ticagrelor therapy before any surgery or dental procedure is performed.1 45 Clinicians performing any invasive procedure should consult with the prescribing clinician before discontinuing ticagrelor.1 45

• Importance of informing patients not to take aspirin dosages exceeding 100 mg daily; advise patient to not take any other aspirin-containing drugs.1

• Importance of informing patients that they will bruise and/or bleed more easily and that a longer than usual time will be required to stop bleeding when taking ticagrelor.1 Importance of patients informing clinicians about any unexpected, prolonged, or excessive bleeding, or blood in urine or stool.1

• Importance of informing patients that ticagrelor can cause dyspnea; advise patient to contact their clinician if they experience any unexpected dyspnea.1

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, particularly drugs that affect bleeding risk (e.g., heparin, warfarin).1

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

• Importance of informing patients of other important precautionary information.1 (See Cautions.)

• Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists.
• You may bleed more easily. Be careful and avoid injury. Use a soft toothbrush and an electric razor.
• If you fall or hurt yourself, or if you hit your head, call your doctor right away. Talk with your doctor even if you feel fine.
• If you are taking digoxin, talk with your doctor. You may need to have your blood work checked more closely while you are taking it with Brilinta.
• Some drugs may look the same as this medicine or may have names that sound like Brilinta (ticagrelor). Always check to make sure you have the right product. If you see any change in the way this medicine looks like shape, color, size, or wording, check with your pharmacist.
• Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using Brilinta while you are pregnant.

Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• Take Brilinta at the same time of day.
• Take with or without food.
• If you cannot swallow the tablet whole, the tablet can be crushed and mixed with water. Drink right away after mixing. Refill the glass with water, stir, and drink.
• Those who have feeding tubes may use the tablet. Crush the tablet and mix it with water. Flush the feeding tube after this medicine is given.
• To gain the most benefit, do not miss doses.
• Keep taking Brilinta as you have been told by your doctor or other health care provider, even if you feel well.

What do I do if I miss a dose?

• Skip the missed dose and go back to your normal time.
• Do not take 2 doses at the same time or extra doses.