Reversible P2Y12 receptor inhibitor
ATC code: B01AC24 (Ticagrelor)
Brand names
Brilinta, Brilique, Possia
A direct reversible antagonist of platelet P2Y12 receptors. Unlike clopidogrel, no bioactivation is needed – effect within 30 minutes of the first dose, independent of CYP2C19 polymorphism. Effect is stronger and more predictable than clopidogrel. Half-life 7–9 hours; twice-daily dosing. After stopping, antiplatelet activity recovers within 5 days.
First line
First-line in dual antiplatelet therapy for acute coronary syndrome (NSTEMI, STEMI, unstable angina) per 2023 alongside prasugrel. Compared with clopidogrel, PLATO showed 16% reduction in cardiovascular death, MI, and stroke (NNT 53) without an increase in non-CABG major bleeding. Loading dose 180 mg; maintenance 90 mg twice daily for 12 months with aspirin 75–100 mg once daily.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Ticagrelor is an antiplatelet drug, a reversible P2Y12 receptor inhibitor. It is prescribed for acute coronary syndrome and for secondary prevention after myocardial infarction ( 2024, 2017). In biohacker and longevity circles, ticagrelor is occasionally promoted for primary CV prevention as a more modern alternative to aspirin. In people without confirmed coronary disease, stroke, or other high CV risk, no clinical studies of primary prevention with ticagrelor exist, and such prescription is dangerous. The drug has serious risks: severe bleeding (including life-threatening intracranial), dyspnea (common, in 14% of patients), bradycardia with syncope risk, and hyperuricemia. If ticagrelor was prescribed without confirmed ACS or post-MI, consider seeking a second opinion.
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Boxed warning
FDA boxed warning: severe and fatal bleeding; not used in active bleeding or recent intracranial hemorrhage. Maximum aspirin dose 100 mg/day – higher doses reduce ticagrelor efficacy.
Limited pregnancy data. Use in pregnancy is not recommended.
Ticagrelor is evaluated for the following indications with varying evidence strength: Acute coronary syndrome (evidence tier A), Primary cardiovascular prevention with aspirin (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ticagrelor (≥ 1 in 100): Dyspnea (15%, without organic cause, usually mild), Bleeding (epistaxis, gingival, hematoma), Headache, Gout flares (uric acid rise), Bradycardia (sinoatrial pauses). See the Safety section for uncommon and serious reactions.
FDA category C. Limited pregnancy data. Use in pregnancy is not recommended.
No data. Not used during lactation.
Ticagrelor is contraindicated in: Ticagrelor hypersensitivity; Active clinically significant bleeding; History of intracranial hemorrhage; Severe hepatic impairment; Concomitant strong CYP3A4 inhibitors. Full list in the Safety section.
FDA boxed warning: severe and fatal bleeding; not used in active bleeding or recent intracranial hemorrhage. Maximum aspirin dose 100 mg/day – higher doses reduce ticagrelor efficacy.
No data. Not used during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.