Ticagrelor for Acute Coronary Syndrome and Post‑PCI Care

What Ticagrelor Is and How It Works

Ticagrelor is an oral antiplatelet from the P2Y12 inhibitor class. It helps prevent clot formation after a heart attack, unstable angina, or coronary stent placement. Ticagrelor tablets are used with low-dose aspirin and are available as 90 mg and 60 mg strengths. The medicine binds reversibly to platelet P2Y12 receptors and reduces platelet activation and aggregation.

CanadianInsulin is a prescription referral service. Prescriptions are verified with your clinic, and orders are filled by licensed Canadian pharmacies. We work with vetted pharmacy partners to supply authentic medications and value-focused pricing.

Ticagrelor acts quickly. After a loading dose, platelet inhibition rises within hours and stays consistent with twice-daily dosing. The medicine is not a blood thinner like warfarin; it targets platelets. It is metabolized by CYP3A4 and has active metabolites. Because of this pathway, strong CYP3A inhibitors or inducers can change exposure and effect.

Common indications include acute coronary syndrome (ACS), myocardial infarction with or without PCI, and continued secondary prevention after the first year post-ACS. Standard practice pairs ticagrelor with aspirin 75–100 mg daily. Aspirin doses above 100 mg may reduce ticagrelor effectiveness and are generally avoided.

If deciding between strengths, clinicians often start with 90 mg twice daily during the first 12 months after an event, then 60 mg twice daily for longer-term prevention if ongoing therapy is appropriate. Always follow the prescribed plan.

Dosage and Usage

• Initiation: Many patients receive a 180 mg loading dose, then 90 mg twice daily with aspirin 75–100 mg daily for up to 12 months.
• Long-term: After 12 months post-ACS, 60 mg twice daily can be used for extended prevention when benefits outweigh risks.
• Administration: Swallow tablets with or without food at the same times each day.
• Crushing: If needed, tablets may be crushed and mixed with water for immediate use or via NG tube, per labeling.
• Aspirin: Use low-dose aspirin (75–100 mg). Higher aspirin doses may lessen ticagrelor benefit.
• Missed dose: Skip the missed dose and take the next dose at the regular time. Do not double doses.
• Drug interactions: Avoid strong CYP3A inhibitors (e.g., ketoconazole, clarithromycin, ritonavir) and inducers (e.g., rifampin, carbamazepine, phenytoin).
• Procedures: Hold ticagrelor about 5 days before surgery when possible to reduce bleeding risk.

• Storage: Keep tablets at 20–25°C (68–77°F); excursions 15–30°C (59–86°F) are permitted.
• Moisture: Store in the original container; keep tightly closed and dry.
• Light and heat: Protect from excessive heat; do not store in a bathroom or glovebox.
• Travel: Keep medicine in a carry-on bag with the original label and a copy of your prescription.
• Consistency: Use a pill organizer if needed, and set reminders to avoid missed doses.

Benefits and Savings

Ticagrelor helps lower the risk of cardiovascular death, heart attack, and stent thrombosis in ACS. It offers rapid, consistent platelet inhibition that is reversible, and it does not require metabolic activation. The twice-daily schedule supports stable platelet blockade throughout the day.

Compared with clopidogrel, ticagrelor showed improved composite cardiovascular outcomes in key trials, especially in certain ACS populations. It can be a good option for patients at higher ischemic risk when the bleeding risk is acceptable. Clinicians often prefer it early after PCI because of its rapid onset.

Many customers save 60–80% vs typical U.S. prices. Strength, quantity, and brand or generic selection influence the final ticagrelor cost.

See our promotions page for current offers, including any ticagrelor coupon if available.

Side Effects and Safety

• Common: Bleeding (nosebleeds, easy bruising), shortness of breath (dyspnea), headache, dizziness.
• GI: Nausea, diarrhea, indigestion.
• Cardiac: Rare bradyarrhythmias or AV block, especially in predisposed patients.
• Lab changes: Increased uric acid and creatinine in some patients.
• Injection/infusion reactions: Not applicable; ticagrelor is an oral tablet.

Serious risks include major bleeding, including gastrointestinal and intracranial hemorrhage. Risk rises with concurrent anticoagulants, NSAIDs, or other antiplatelets. Avoid use in active pathological bleeding or prior intracranial hemorrhage. Caution in severe hepatic impairment. Dyspnea is usually mild or transient but may require evaluation if persistent or severe. Hypoglycemia is not caused by ticagrelor, but patients on insulin or sulfonylureas should still monitor glucose per care plans.

Onset Time

Platelet inhibition begins within 30 minutes of a loading dose and peaks within 2–4 hours. Without a loading dose, steady antiplatelet effect develops over several doses. Clinical benefits, like reduction in recurrent ischemic events, accrue over weeks to months with continuous therapy. Dyspnea, when it occurs, often appears early and may lessen with continued use.

Compare With Alternatives

The branded version of ticagrelor is Brilinta® (same active ingredient), offering identical clinical performance when matched for dose and administration. Patients may choose the generic to reduce ticagrelor price while keeping the same efficacy and safety profile.

Clopidogrel (brand Plavix®) is a once-daily thienopyridine prodrug. It requires metabolic activation and has a slower onset. It may suit patients with lower ischemic risk or higher bleeding risk, or those unable to tolerate ticagrelor. For more on clopidogrel, see Clopidogrel 75 Mg Trusted Antiplatelet For Stroke Risk.

Prasugrel (brand Effient®) is a potent once-daily P2Y12 inhibitor used mainly after PCI. It is effective but is contraindicated in patients with prior stroke or TIA and used cautiously in older or low‑weight patients. Choice among ticagrelor, clopidogrel, and prasugrel depends on ischemic risk, bleeding risk, and clinical context.

For additional background on dosing and risks, review Ticagrelor 90 Mg How It Works Dosage And Risks.

Combination Therapy

• Aspirin: Use with low-dose aspirin (75–100 mg daily) unless contraindicated.
• Anticoagulants: Combining with warfarin or DOACs increases bleeding risk; careful selection and monitoring are required.
• Other antiplatelets: Dual therapy is standard post-PCI; triple therapy raises bleeding risk and duration is minimized.
• Statins: Atorvastatin and rosuvastatin are commonly co-prescribed; monitor for interactions per labeling.
• PPIs/H2 blockers: May help reduce GI bleeding risk in high-risk patients.
• NSAIDs: Avoid routine NSAID use due to additive bleeding risk.

Patient Suitability and Cost-Saving Tips

Ticagrelor suits many adults with ACS, recent myocardial infarction, and those who received a stent and need dual antiplatelet therapy. It is not for active bleeding, prior intracranial hemorrhage, or severe hepatic impairment. Caution is advised in bradyarrhythmias, gout or hyperuricemia, and with drugs that strongly affect CYP3A4.

Pregnancy and breastfeeding data are limited. Prescribers weigh maternal benefit against potential risks. In older adults or those with low body weight, bleeding risk is considered carefully. For planned surgery or dental procedures, therapy is usually paused in advance when feasible.

Ways to manage ticagrelor cost include selecting the generic, choosing multi-month supplies when appropriate, and aligning refills to reduce separate shipments. CanadianInsulin offers prompt, express, cold-chain shipping for temperature-sensitive products and careful handling for tablets. Reorder reminders can help avoid lapses in antiplatelet therapy.

Authoritative Sources

AstraZeneca Brilinta Prescribing Information

Health Canada Drug Product Database: Ticagrelor

FDA Label and Medication Guide for Ticagrelor

Order Ticagrelor from CanadianInsulin: add to cart, upload your prescription, and we ship with prompt, express, cold-chain handling.

This page is educational and does not replace advice from your healthcare professional. Always follow the guidance of your prescriber and pharmacist.