Brilinta and Plavix are brand names for prescription drugs used to prevent blood clots that can clump together causing a blockage of blood flow in people with acute coronary syndrome (ACS) or a history of myocardial infarction (heart attack).
Here we will explain how they work, their similarities and differences, their side effects, and more. This should provide you with the basics to better understand your options.
What is Brilinta?
Brilinta is an FDA (U.S. Food and Drug Administration) approved medication manufactured by AstraZeneca. It is a medication used to reduce the risk of heart attacks, strokes, and death caused by blood clots. It’s prescribed to adults who:
- Have previously had a heart attack
- Have coronary artery disease (CAD) and who are at a high risk of having a heart attack or a stroke
- Have acute coronary syndrome (ACS)
- Have ACS and who have been treated with a stent
If you have CAD, ACS, or have a stent due to ACS, you may be at a higher risk of blood clots. Brilinta helps to stop your blood clotting, reducing your risk of a heart attack or stroke. The active ingredient in Brilinta, ticagrelor, inhibits platelet activation by binding to receptors on the surface of your platelets. This stops them from being able to stick together preventing the process that causes clotting.
Brilinta dosage
Brilinta is available in tablet form, in the following doses: 60 mg and 90 mg. Your loading dose and maintenance dose will be based on the condition you are being treated for. Take Brilinta with a daily dose of aspirin of 75-100 mg.
There is a high risk of stent thrombosis, or blood clots forming after stent placement (percutaneous coronary intervention/PCI). To stop thrombosis, Brilinta or Plavix can be used to reduce platelet aggregation and prevent blood clots around the stent.
Take Brilinta for at least 12 months after stent placement. After the first 12 months, take Brilinta for a further 12 months at a reduced dose. Your doctor will decide your dose at your follow-up appointment to determine any changes.
What is Plavix?
Plavix is an FDA (U.S. Food and Drug Administration) approved medication manufactured by Bristol-Myers Squibb – Sanofi Pharmaceuticals. It is a platelet inhibitor used for:
- Acute coronary syndrome – for patients with increased non-ST-segment ACS (unstable angina/non-ST-elevation myocardial infarction) including those who are managed medically and those who are to be managed with coronary revascularization, Plavix has been shown to reduce the rate of a combined endpoint of cardiovascular death, MI, or stroke as well as the rate of a combined endpoint of cardiovascular death, MI, stroke, or refractory ischemia. For those patients with ST-elevation myocardial infarction (STEMI), Plavix has been shown to reduce the death rate from any cause and the death rate of a combined endpoint, re-infarction, or stroke
- Recent myocardial infarction, stroke, or established peripheral arterial disease. Plavix has been shown to reduce the combined endpoint of new ischemic stroke, MI, and other vascular death
Plavix dosage
Plavix is available in tablet form, in the following doses: 75 mg, and 300 mg.
For acute coronary syndrome – Non-ST-segment elevation ACS, take 300 mg as a loading dose followed by 75 mg once daily, in combination with aspirin (75-325 mg once daily). For STEMI take 75 mg once daily, in combination with aspirin (75-325 mg once daily), with or without a loading dose, and with or without thrombolytic. For recent MI, stroke, or established peripheral arterial disease take 75 mg once daily.
Common side effects of Brilinta and Plavix
The most common side effects of Brilinta in clinical trials include:
- An increase in minor bleeding, including nosebleeds and bruising
- Shortness of breath (dyspnea)
- Dizziness
- Feeling sick (nausea)
More serious side effects of Brilinta include:
- An increased risk of serious internal and external bleeding that could potentially be fatal
- Severe allergic reactions to the medication that could cause swelling in your face, mouth, or throat, heart palpitations, or problems breathing
The most common side effects of Plavix in clinical trials include:
- Bleeding, including life-threatening and fatal bleeding
- Nosebleeds
- Bleeding gums
- Heavier menstrual bleeding
- Unexpected vaginal bleeding
More serious side effects of Plavix include
- Bleeding in your brain and spinal column
- Bleeding in your lungs
- Bleeding into a muscle
- Unusual bleeding events
- Vomiting blood that looks like coffee grounds
- Higher risk of bleeding
- Premature discontinuation of Plavix increases the risk of cardiovascular events
- Recent transient ischemic attack or stroke – the combination use of Plavix and aspirin was shown to increase the risk of major bleeding
- Thrombotic thrombocytopenic purpura (TTP)
These aren’t all the side effects Brilinta or Plavix can cause. You can find more details in the patient leaflet that comes with your medication. If you have any concerns about side effects, talk to your physician or pharmacist.
Brilinta and Plavix drug interactions
Brilinta can interact with other medications. These include:
- Any medications taken to treat heart conditions, high blood pressure, or high cholesterol
- Any blood thinner (anticoagulant) medications taken to reduce your risk of blood clots
- Any pain killers – codeine
- Any antibiotics – erythromycin
- Any medications taken to treat HIV/AIDS
- Any antifungal medicines taken orally
- Any anti-seizure medications – phenytoin
Plavix can interact with other medications. These include:
- Strong or moderate CYP2C19 inhibitors, such as omeprazole
- Blood thinners – warfarin
- Antifungal medicine – fluconazole
- Immunosuppressants – ozanimod
- NSAIDs (Non-steroidal anti-inflammatory drugs) – ibuprofen, naproxen
- Any selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants
- Antiarrhythmics – amiodarone
- Treatments for seizures – phenytoin
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Combination use increases risk of gastrointestinal bleeding. (7.2) • Warfarin: Combination use increases risk of bleeding
Brilinta and Plavix can interact with other medications. This can change how Brilinta and Plavix and other medications work and can make side effects more likely. Tell your prescribing physician about all your drugs, including vitamins and dietary supplements.
Brilinta and Plavix contraindications
You should not use Brilinta if you:
- Are allergic to the active ingredient ticagrelor
- Are allergic to any of the other ingredients in Brilinta
- Have ever had bleeding in your brain
- Are currently bleeding
Talk to your doctor before using Brilinta if you:
- Have ever had a stroke
- Have ever had any problems with bleeding
- Have ever had stomach ulcers or colon polyps
- Have any liver problems
- Have asthma or chronic obstructive pulmonary disease (COPD)
- Have recently had surgery or a serious injury
- Are planning to have surgery or a dental procedure
- Are pregnant or are planning to become pregnant
- Are breastfeeding or are planning to breastfeed
You should not use Plavix if you:
- Are allergic to clopidogrel
- Have any active bleeding
- Have a stomach ulcer or bleeding in the brain
- Are breastfeeding or are planning to breastfeed
Talk to your doctor before using Plavix if you:
- Have an ulcer in your stomach or intestines
- Have a bleeding disorder or blood clotting disorder
- Are pregnant or are planning to become pregnant
Other drugs for blood clots
According to the American Heart Association (AHA) and American College of Cardiology (ACC), Brilinta is the preferred treatment for people with ACS. This is based on the PLATO trial, which showed that Brilinta works better than Plavix at preventing heart attacks, strokes, and deaths from heart disease in people with acute coronary syndrome (ACS).
If you are prescribed Brilinta or Plavix, you will almost always be prescribed aspirin. The combination of aspirin and P2Y12 inhibitors is called dual antiplatelet therapy (DAPT).
If you have any concerns about Brilinta or Plavix side effects, talk to your physician, or pharmacist for medical advice. Also inform your healthcare provider about any medical conditions, supplements, and over-the-counter meds you are taking. You are also encouraged to report side effects to the FDA: visit http://www.fda.gov/medwatch or call 1-800-FDA-1088.
