Brilinta interactions: Alcohol, medications, and other factors

Brilinta (ticagrelor) is a brand-name prescription drug. It’s approved to reduce the risk of heart attack, stroke, and cardiovascular-related death in adults with certain cardiovascular conditions. As with other medications, Brilinta can interact with certain other drugs. It can also interact with some supplements and foods. An interaction occurs when one substance causes another substance to have a different effect than expected.

For details about Brilinta’s interactions, keep reading. For additional information about Brilinta, including details about its uses, see this article.

In some cases, factors or conditions could prevent your doctor from prescribing Brilinta due to the risk of harm. These are known as contraindications. The contraindications of Brilinta include:

Having active bleeding

Doctors typically will not prescribe Brilinta for people with active (current) bleeding, such as a bleeding ulcer.

This is because Brilinta may cause severe bleeding that can be life threatening. This side effect could worsen any bleeding you already have.

If you have active bleeding, your doctor will likely try to manage your bleeding before prescribing Brilinta.

Having had a brain hemorrhage

Doctors typically will not prescribe Brilinta for people who’ve had a brain hemorrhage (bleeding in the brain).

This is because Brilinta may increase your risk of having another brain hemorrhage. If you’ve had this condition in the past, your doctor will recommend a treatment option other than Brilinta for you.

Having had an allergic reaction to Brilinta or any of its ingredients

If you’ve had an allergic reaction to Brilinta or any of its ingredients, your doctor will likely not prescribe Brilinta. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Brilinta, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Brilinta.

There isn’t a known interaction between Brilinta and alcohol.

However, Brilinta and alcohol can increase your risk of bleeding. This is because both Brilinta and alcohol may prevent blood from clotting. So, consuming alcohol while taking Brilinta could further increase your risk of bleeding.

If you drink alcohol, talk with your doctor. They can advise you on whether there’s a safe amount to consume while taking Brilinta.

Before you start treatment with Brilinta, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Brilinta interacts with supplements, herbs, or vitamins, see the “Brilinta and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Brilinta. Keep in mind that this table doesn’t include all drugs that may interact with Brilinta. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* Brilinta is usually prescribed in combination with aspirin. However, the drug has a boxed warning about the use of aspirin above a certain dosage. This is a serious warning from the Food and Drug Administration (FDA). To learn more, see “Boxed warnings” at the top of this article.

Here’s a closer look at certain drug interactions of Brilinta.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain, fever, and inflammation.

Interaction result. Bleeding is a possible side effect of both Brilinta and NSAIDs. Taking Brilinta with an NSAID can increase your risk of bleeding even further.

Interaction explained. Brilinta belongs to a class of drugs called antiplatelet agents. It works by preventing platelets (a type of red blood cell) from grouping together to form a blood clot. If your blood isn’t able to clot as it usually would, this can increase your risk of bleeding.

NSAIDs can also prevent platelets from grouping together. By affecting platelets, NSAIDs also increase your risk of bleeding.

When Brilinta is taken in combination with an NSAID, the risk of bleeding with either drug is even greater.

Examples of NSAID drugs. Here are some NSAIDs that may interact with Brilinta:

• ibuprofen (Advil, Motrin)
• naproxen (Aleve, Naprosyn)
• meloxicam (Mobic)
• celecoxib (Celebrex)

Steps you or your doctor may take. Before starting treatment with Brilinta, tell your doctor if you take any NSAIDs. They can advise you on whether it’s safe to take Brilinta with an NSAID.

It’s important to remember that certain NSAIDs are available without a prescription. If you’d like to take an NSAID or other pain reliever, talk with your doctor or pharmacist first. They can recommend which pain reliever is safe to take with Brilinta. For example, it’s likely safe to take Brilinta with acetaminophen (Tylenol).

Blood thinners

Blood thinners are used to help prevent or treat blot clots.

Interaction result. Brilinta and blood thinners can cause bleeding as a side effect. Taking Brilinta in combination with a blood thinner can raise your risk of bleeding further.

Interaction explained. Brilinta belongs to a class of drugs called antiplatelet agents. It works by stopping platelets (a type of red blood cell) from sticking together to form a blood clot. If your blood isn’t able to clot correctly, your risk of bleeding may increase.

Bleeding is also a possible side effect of blood thinners. When Brilinta is taken in combination with a blood thinner, the risk of bleeding is even higher.

Examples of blood thinner drugs. Here are some blood thinners that may interact with Brilinta:

• warfarin (Jantoven)
• heparin
• apixaban (Eliquis)
• dabigatran (Pradaxa)
• rivaroxaban (Xarelto)

Steps you or your doctor may take. Your doctor can recommend whether it’s safe to take Brilinta with a blood thinner.

If you do take Brilinta with a blood thinner, tell your doctor right away if you have symptoms of bleeding. Examples of these symptoms include:

• bloody stool or urine
• coughing up blood
• unexplained bruising
• bleeding from your nose or gums that takes a long time to stop

Certain statin drugs

Statins are used to lower blood cholesterol levels.

Interaction result. The specific statins that may interact with Brilinta include lovastatin (Altoprev) and simvastatin (FloLipid, Zocor). Taking Brilinta in combination with these drugs can increase your risk of side effects from these statins.

Interaction explained. An enzyme called cytochrome P450 3A4 (CYP3A4) breaks down lovastatin and simvastatin in the body. An enzyme is a type of protein.

Brilinta slows down the activity of CYP3A4. When the activity of this enzyme slows, it takes your body longer than usual to break down lovastatin or simvastatin. This could lead to higher levels of these drugs in your body. As a result, your risk of side effects from lovastatin or simvastatin may increased. This risk is greater at higher doses of lovastatin or simvastatin.

Steps you or your doctor may take. Before taking Brilinta, be sure to tell your doctor if you take lovastatin or simvastatin. Lower doses of lovastatin or simvastatin may be safe to take with Brilinta. For this reason, your doctor may prescribe a daily lovastatin or simvastatin dose of 40 milligrams (mg) or less.

If you have questions about taking Brilinta along with lovastatin or simvastatin, talk with your doctor.

Brilinta may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Brilinta.

Brilinta interactions with supplements

Before you start treatment with Brilinta, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Brilinta interactions with herbs

Brilinta may interact with an herb called St. John’s wort. Taking Brilinta with this supplement could make Brilinta less effective.

Brilinta and vitamins

There are no specific reports of vitamins interacting with Brilinta. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Brilinta.

Brilinta interactions with food

Brilinta may interact with grapefruit and grapefruit juice. Taking this drug with grapefruit products could raise the level of Brilinta in your body. This could increase your risk of bleeding as a side effect of the drug.

To learn more about eating grapefruit or drinking grapefruit juice while taking Brilinta, talk with your doctor.

Brilinta and vaccines

There aren’t any known interactions between Brilinta and vaccines. If you have questions about getting specific vaccines during Brilinta treatment, talk with your doctor.

Brilinta and lab tests

Brilinta isn’t known to interact with any lab tests. If you have questions about getting specific lab tests during Brilinta treatment, talk with your doctor.

BRILINTA INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Brilinta.

Taking this drug with cannabis products could raise the level of Brilinta in your body. This could increase your risk of bleeding as a side effect of the drug.

Before you start treatment with Brilinta, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many U.S. states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Brilinta. Before you take this drug, be sure to talk with your doctor about your health history. Brilinta may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Brilinta include:

• Active bleeding. If you have active (current) bleeding, such as a bleeding ulcer, your doctor will not prescribe Brilinta. For details, see the “When to avoid Brilinta” section above.
• Brain hemorrhage. If you’ve had a brain hemorrhage (bleeding in the brain), your doctor will not prescribe Brilinta. For details, see the “When to avoid Brilinta” section above.
• Breathing problems. Before taking Brilinta, tell your doctor if you have a breathing problem. Examples include asthma or chronic obstructive pulmonary disease (COPD). Brilinta may cause shortness of breath as a side effect, which could worsen your breathing condition. Your doctor can advise whether Brilinta is a safe treatment option for you.
• Liver problems. If you have a severe liver problem, such as cirrhosis, your doctor may not prescribe Brilinta. It isn’t known whether the drug is safe for people who have severe liver problems. If you have a liver problem, your doctor may recommend a different treatment option instead.
• Problems with heart rate or heart rhythm. Before taking Brilinta, tell your doctor if you have a problem with your heart rate or heart rhythm. Examples include sick sinus syndrome and heart block. It isn’t known whether the drug is safe for people who have these heart rate or heart rhythm problems. Your doctor may recommend a different treatment option instead.
• Planned surgery. Certain surgeries may increase your risk of bleeding. Bleeding is also a possible side effect of Brilinta. Having surgery while you’re taking this drug could increase your risk of bleeding further. For this reason, your doctor may temporarily stop your Brilinta treatment a few days before a planned surgery. This could lower your risk of bleeding with the surgery.
• Pregnancy. It’s not known whether Brilinta is safe to take while pregnant. For details about Brilinta and pregnancy, see this article.
• Breastfeeding. It’s not known whether Brilinta passes into breast milk or if the drug causes side effects in a breastfed child. To be safe, your doctor is likely to recommend that you avoid breastfeeding while taking Brilinta. For more information about taking Brilinta while breastfeeding, see this article.
• Allergic reaction. If you’ve had an allergic reaction to Brilinta or any of its ingredients, your doctor will likely not prescribe Brilinta. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

You can take certain steps to help prevent interactions with Brilinta. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Brilinta label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Brilinta doesn’t come with paperwork, you can ask your pharmacist to print a copy.) If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Brilinta by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Brilinta. These resources might help:

• Overview of Brilinta. For a general overview of Brilinta, see this article.
• Facts about blood clots, heart attack, and stroke. To learn more about blood clots, heart attack, or stroke, see our cardiovascular health hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.