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Brilinta vs Plavix: what's the difference?

Which is better or more effective Brilinta or Plavix?

Medically reviewed by Melisa Puckey, BPharm. Last updated on Jul 8, 2020.

Official Answer

by Drugs.com

Effectiveness of Brilinta vs Plavix

Using PLATO clinical trial figures Brilinta appears to be more effective than Plavix at reducing the risk of CV death, MI or stroke in the first year of treatment.

The PLATO clinical trial studied Brilinta + aspirin compared to Plavix + Aspirin, was sponsored by AstraZeneca which makes Brilinta. The percentage of patients that had cardiovascular (CV) death, myocardial infarction (MI) or stroke in the first year of treatment was:

  • Brilinta + aspirin = 9.8%
  • Plavix + aspirin =11.7%

The CURE clinical trial studied Plavix + aspirin compared to placebo + aspirin. The percentage of CV death, MI or stroke in the first year of treatment was

  • Plavix + aspirin = 9.3%
  • placebo + aspirin = 11.4%

In the CURE study Plavix + aspirin had a lower rate of CV death, MI or stroke in the first year of treatment.

Brilinta (ticagrelor) and Plavix (clopidogrel) are used to prevent blood clots in patients with heart issues to reduce risk of having a stroke, serious heart problems, or death.

Boxed warnings of Brilinta vs Plavix

Brilinta and Plavix both have boxed warnings, but for different issues.

Plavix boxed warning is for

  • "CYP2C19 poor metabolizers " as their bodies are unable to convert Plavix into the active form, so that it has a limited effect in these people.

Brilinta has two boxed warnings

  • bleeding risk
  • doses of aspirin above 100 mg daily reduce effectiveness of Brilinta therefore should be avoided.

Side Effects of Brilinta vs Plavix

Like all medications Brilinta and Plavix have side effects, the most commonly discussed side effect is bleeding for both medicines, due to their effects on reducing blood clotting. There are a number of different studies measuring the bleeding side effect, but the different studies have different severity of bleeding categories and different ways of measuring this side effect. This makes it hard to compare whether Brilinta or Plavix has more bleeding side effects.

Brilinta patients have a higher level of breathing difficulties (dyspnea) when compared to Plavix.

For more information on other side effects click on

Dosing of Brilinta vs Plavix

Plavix is a once a day tablet compared to Brilinta which is a twice a day tablet.

Table comparing Brilinta and Plavix

Brilinta (ticagrelor) Plavix (clopidogrel)
Indication Acute coronary
syndrome or a history of myocardial infarction.
Coronary artery disease but no prior stroke or myocardial infarction.
Acute coronary syndrome.
Recent MI, recent stroke, or established peripheral arterial disease.
Boxed warning

Yes: Bleeding risk, reduced effect with aspirin dose above 100mg day

Yes: Reduced effect on patients who are "CYP2C19 poor metabolizers"
FDA approval date 20 July 2011 17 November 1997
Generic availability No Yes
Action Reversibly interact with the platelet P2Y12 ADP-receptor Irreversible binding to the P2Y12 class of ADP receptors on platelets.
Form 60mg oral tablet
90mg oral tablet
75mg oral tablet
300mg oral tablet
Frequency Twice daily Once daily
Dosage Acute coronary syndrome or a history of myocardial infarction: 180mg loading dose then 90mg twice daily for one year, then reduce to 60mg twice daily
Coronary artery disease but no prior stroke or myocardial or infarction: 60 mg twice daily
Acute Coronary Syndrome: loading dose 300mg then 75mg once daily
Recent MI, Recent Stroke, or Established Peripheral Arterial Disease: 75mg daily - no loading dose required
Antidote No No
Most commonly reported side effects Bleeding 11.6 %, breathing difficulties 15-21% Bleeding 11.2%
Interactions Simvastatin, lovastatin, digoxin, opioids, aspirin, strong CYP3A inducers, strong CYP3A Inhibitors CYP2C19 inhibitors, omeprazole or esomeprazole, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin (CYP2C9 Substrates), SSRIs and SNRIs, repaglinide (CYP2C8 substrates)
Effectiveness: (Number of patients who had a cardiovascular death, MI or stroke in first year) Ticagrelor + aspirin = 9.8% (PLATO study)


Plavix + aspirin =11.7% (PLATO study)

Plavix +aspirin = 9.3% (CURE study)

Bottom Line:

  • Brilinta appears to be slightly more effective than Plavix in reducing the percentage of CV death, MI or stroke in the first year of treatment
  • Brilinta patients had more breathing difficulties as a side effect compared to Plavix patients.
  • Brilinta has a blackbox warning for severity of bleeding risk and also for reduced effect with aspirin dose above 100mg day.
  • Plavix has a black box warning for patients patients who are "CYP2C19 poor metabolizers” as Plavix will have reduced effect on these patients.
References

 

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