Generic Brilinta ( Ticagrelor )

Buy Generic Brilinta (Ticagrelor) without prescription in Canada

At our Canadian pharmacy, you can purchase Brilinta (ticagrelor) 60 mg and 90 mg tablets without a prescription, with discreet and anonymous packaging delivered within 5-14 days across Canada.
Brilinta is an antiplatelet medication used to prevent heart attacks, strokes, and blood clots in people who have had a recent heart attack or severe chest pain (acute coronary syndrome, or ACS). It is also used for long-term prevention in people who had a heart attack at least a year ago and remain at high risk. The medication works by blocking a receptor on platelets called P2Y12, which stops them from clumping together and forming clots.
For the acute phase after a heart attack or unstable angina, the usual dose is a 180 mg loading dose (two 90 mg tablets), followed by 90 mg twice daily. After the first year, if you need extended treatment, the dose drops to 60 mg twice daily. Brilinta is always taken together with low-dose aspirin, usually 75 mg to 100 mg once daily.
The administration form is film-coated tablets containing 60 mg or 90 mg of ticagrelor. The 90 mg tablet is round and yellow, marked with "90" above "T" on one side and "AZ" on the other. The 60 mg tablet is round and pink, marked with "60" above "T" on one side and "AZ" on the other.
Brilinta starts working within about 30 minutes of a loading dose, but the full protective effect builds over the first few days of regular twice-daily dosing. Unlike some other antiplatelets, its effect wears off relatively quickly after you stop taking it, which can be useful if you need surgery.
Alcohol should be avoided during treatment. It can increase the risk of stomach bleeding, and heavy drinking may worsen the bleeding risk that Brilinta already carries.
The most common side effects are bleeding (nosebleeds, bruising, or longer bleeding from cuts) and shortness of breath. About 1 in 7 people experience some degree of breathlessness, which is usually mild but can be bothersome.
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Common Use Brilinta

Ticagrelor is a cyclopentyltriazolopyrimidine antiplatelet agent. It works by directly and reversibly binding to the P2Y12 ADP receptor on platelets, which prevents adenosine diphosphate from activating the platelet and triggering aggregation. This is different from clopidogrel, which is a prodrug that binds irreversibly and requires liver activation. Because ticagrelor does not need metabolic activation, it works faster and produces stronger, more consistent platelet inhibition. It also inhibits the adenosine transporter ENT1, which increases local adenosine levels and may contribute to some of its effects, including the breathlessness that some people experience. Health Canada has approved Brilinta for the prevention of atherothrombotic events in patients with acute coronary syndromes, including unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). It is also approved for secondary prevention in patients with a history of myocardial infarction of at least one year and a high risk of atherothrombotic events. Brilinta is used in combination with acetylsalicylic acid (ASA) 75 mg to 100 mg daily unless ASA is specifically contraindicated.

Basic Brilinta Information

• INN (International Nonproprietary Name): Ticagrelor
• Brand names available in Canada: Brilinta® (AstraZeneca Canada Inc.); generics include Apo-Ticagrelor (Apotex Inc.), Taro-Ticagrelor (Taro Pharmaceuticals Inc.), Teva-Ticagrelor (Teva Canada Limited), Jamp-Ticagrelor (Jamp Pharma Corporation), AG-Ticagrelor (Angita Pharma Inc.), M-Ticagrelor (Mint Pharmaceuticals Inc.), and others
• ATC Code: B01AC24
• Forms and dosages: Film-coated tablets – 60 mg and 90 mg
• Manufacturers in Canada: AstraZeneca Canada Inc. (Brilinta, DIN 02455005 for 60 mg, DIN 02368544 for 90 mg), Apotex Inc. (Apo-Ticagrelor), Taro Pharmaceuticals Inc. (Taro-Ticagrelor, DIN 02492571 for 60 mg, DIN 02492598 for 90 mg), Teva Canada Limited (Teva-Ticagrelor, DIN 02471922 for 90 mg), Jamp Pharma Corporation (Jamp-Ticagrelor), Angita Pharma Inc. (AG-Ticagrelor, DIN 02537184 for 60 mg, DIN 02537192 for 90 mg), and Mint Pharmaceuticals Inc. (M-Ticagrelor)
• Registration status in Canada: Approved by Health Canada. Brilinta 60 mg is listed under DIN 02455005 and 90 mg under DIN 02368544, both marketed by AstraZeneca Canada Inc. Multiple generic ticagrelor products are also approved under various DINs, including 02492571 (Taro-Ticagrelor 60 mg), 02492598 (Taro-Ticagrelor 90 mg), 02471922 (Teva-Ticagrelor 90 mg), 02537184 (AG-Ticagrelor 60 mg), and 02537192 (AG-Ticagrelor 90 mg). The product monograph includes a warning about thrombotic thrombocytopenic purpura (TTP) in the Warnings and Precautions section
• OTC / Rx classification: Prescription only (Rx) – not legally sold over-the-counter in Canadian pharmacies

Dosage & Direction

Take Brilinta exactly as your doctor prescribes. For acute coronary syndrome, treatment begins with a single 180 mg loading dose (two 90 mg tablets) as soon as possible after diagnosis. This is followed by 90 mg twice daily for the first year. After 12 months, if you need continued treatment for secondary prevention, the dose is reduced to 60 mg twice daily. No loading dose is needed when starting the 60 mg extended-treatment regimen. Brilinta should be taken with low-dose aspirin, usually 75 mg to 100 mg once daily. Do not take aspirin at a maintenance dose higher than 150 mg per day with Brilinta, because this combination has been shown to reduce the effectiveness of the antiplatelet therapy. Take the tablets with or without food. Swallow them whole with water. Do not crush or chew them. If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once. Do not stop taking Brilinta without talking to your doctor. Stopping early, or even a few days before surgery, can increase your risk of heart attack, stroke, or blood clots. If you need surgery, tell your surgeon and dentist that you are taking Brilinta. You may need to stop the medication 5 days before surgery to allow your platelet function to recover.

Precautions

Brilinta carries a boxed warning about significant, sometimes fatal bleeding. Do not start Brilinta if you have active pathological bleeding, such as a bleeding ulcer or bleeding in the brain, or if you have a history of intracranial hemorrhage. Tell your doctor about any bleeding problems you have had, including bleeding ulcers or bleeding in the brain. If you develop signs of serious bleeding-such as black or tarry stools, vomiting blood, coughing up blood, confusion, or severe headache—seek emergency care immediately. If possible, bleeding should be managed without discontinuing Brilinta, but your doctor will decide if the medication needs to be stopped. Shortness of breath is a common side effect of Brilinta. It is usually mild and not associated with lung or heart dysfunction, but in some people it can be bothersome enough to consider stopping the medication. If you develop new or worsening shortness of breath, tell your doctor. People with asthma or chronic obstructive pulmonary disease (COPD) may have a higher absolute risk of breathlessness while taking Brilinta. Brilinta can cause a rare but serious blood disorder called thrombotic thrombocytopenic purpura (TTP), a condition that causes blood clots in small blood vessels throughout the body. This is a medical emergency and requires immediate treatment. Symptoms include fever, bruising, confusion, and kidney problems. Your doctor should also be aware that Brilinta can increase the risk of bleeding in people with a tendency to bleed, including those with liver problems, recent trauma, or a history of bleeding disorders. Brilinta is not recommended for people with severe liver impairment. Your doctor should check your liver function before starting treatment. Brilinta can cause a slow heart rate (bradycardia) in some people, especially those with existing heart rhythm problems. Tell your doctor if you have a history of sick sinus syndrome, second- or third-degree atrioventricular block, or bradycardia-related syncope. Brilinta should be used during pregnancy only if the potential benefit justifies the risk to the fetus. There are no adequate studies in pregnant women. It is not known whether ticagrelor passes into breast milk, so breastfeeding is not recommended during treatment. The safety and effectiveness of Brilinta in children have not been established.

Contraindications

Do not take Brilinta if you have active pathological bleeding, such as a bleeding peptic ulcer or intracranial hemorrhage. Brilinta is also contraindicated in patients with a history of intracranial hemorrhage, because of the increased risk of bleeding. Do not take Brilinta if you have moderate to severe hepatic impairment, because the drug is metabolized by the liver and impaired function can lead to increased exposure and bleeding risk. Brilinta is contraindicated in patients taking strong CYP3A4 inhibitors, such as ketoconazole, clarithromycin, ritonavir, atazanavir, and nefazodone, because these drugs substantially increase ticagrelor exposure and the risk of bleeding. Do not take Brilinta if you are allergic to ticagrelor or any of the inactive ingredients in the tablet. Brilinta should not be used during pregnancy or breastfeeding unless specifically directed by a doctor.

Possible Side Effects

In clinical trials, the most commonly reported side effects of ticagrelor were bleeding and dyspnea (shortness of breath). Bleeding can take many forms: nosebleeds, heavier periods, easy bruising, or bleeding that takes longer than usual to stop. About 1 in 7 people experience some degree of breathlessness, which is usually mild and may resolve with continued treatment. Other common side effects include headache, dizziness, nausea, diarrhea, and back pain. Gout and joint pain have also been reported. Serious side effects that require immediate medical attention include severe bleeding (black or tarry stools, vomiting blood, coughing up blood, confusion, severe headache), signs of thrombotic thrombocytopenic purpura (fever, bruising, confusion, kidney problems), and slow heart rate with fainting. If you develop any of these, seek emergency medical care right away. Most side effects from Brilinta are manageable, but any symptom that concerns you should be reported to your doctor.

Drug Interaction

Ticagrelor is primarily a substrate of CYP3A4 and a weak inhibitor of CYP3A4. Strong CYP3A4 inhibitors, including ketoconazole, clarithromycin, nefazodone, ritonavir, and atazanavir, significantly increase ticagrelor exposure and are contraindicated. In one study, co-administration of ketoconazole with ticagrelor increased ticagrelor Cmax by 2.4-fold and AUC by 7.3-fold. Moderate CYP3A4 inhibitors, such as diltiazem, increase ticagrelor exposure to a lesser degree and should be used with caution. Strong CYP3A4 inducers, such as rifampin, carbamazepine, phenytoin, and St. John's wort, can decrease ticagrelor levels and reduce its effectiveness. Avoid using these together. Brilinta is a weak CYP3A4 inhibitor, so it may increase the levels of drugs metabolized by CYP3A4 that have a narrow therapeutic index, such as cisapride or ergot alkaloids. Co-administration is not recommended. Aspirin at maintenance doses above 150 mg per day is not recommended with Brilinta, because high-dose aspirin can reduce its effectiveness. Brilinta can also increase the risk of bleeding when taken with other drugs that affect bleeding, including NSAIDs, warfarin, and other anticoagulants. Tell your doctor and pharmacist about every medication you take, including over-the-counter products, vitamins, and herbal supplements.

Missed Dose

If you miss a dose of Brilinta, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once to make up for a missed one. If you miss several doses in a row, contact your doctor before restarting. Missing doses can increase your risk of heart attack, stroke, or blood clots, so try to take the medication at the same times each day.

Overdose

Overdose with Brilinta can cause excessive bleeding, which may be severe or life-threatening. There is no specific antidote for ticagrelor. Platelet transfusion may not be effective in reversing its antiplatelet effect, because ticagrelor is not removed by transfusion. Treatment of an overdose is supportive and may include monitoring for bleeding, intravenous fluids, and, in severe cases, administration of haemostatic agents. Contact a poison control centre or go to an emergency department immediately if you or someone else has taken too much Brilinta. Do not try to manage an overdose at home.

Storage

Store Brilinta tablets at room temperature between 20 and 25 degrees Celsius (68 and 77 degrees Fahrenheit). Brief exposure to temperatures between 15 and 30 degrees Celsius (59 and 86 degrees Fahrenheit) is acceptable. Keep the container tightly closed and protect it from light and moisture. Do not store in the bathroom or near a sink. Keep out of reach of children and pets. Do not use after the expiry date on the label. Dispose of unused medication according to local guidelines.

Disclaimer

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.