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What pain medication can I take with Brilinta?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Nov 12, 2020.

Official Answer

by Drugs.com

Brilinta (ticagrelor) is in a class of drugs known as antiplatelets that is taken twice a day, in the morning and the evening. It is often prescribed for acute coronary syndrome (severe chest pain or after a heart attack) or to help prevent a blood clot formation in a cardiac (heart) stent.

It is also approved to reduce the risk of a first heart attack or stroke in patients with coronary artery disease (CAD) at high risk for such events. It is also used to reduce the risk of stroke in patients with acute ischemic stroke or high-risk transient ischemic attack (TIA).

Your doctor will prescribe a low dose of aspirin to take together with Brilinta (ticagrelor) to help prevent a blood clot. Do not take extra aspirin or NSAIDs like ibuprofen, naproxen or celecoxib for pain relief unless your doctor has directed you to take these medications.

  • Additional aspirin or NSAIDs may increase your risk for serious bleeding, including stomach bleeding.
  • Additional aspirin over the amount your doctor prescribes to use with Brilinta can lower the beneficial effect of Brilinta.
  • If you need a mild pain reliever, it is safe to take acetaminophen (Tylenol) with Brilinta.
  • Tell your doctor if you take medicines that contain aspirin or an NSAID.

Many nonprescription, over-the-counter (OTC) products contain aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve). These ingredients can also be found in combination products used for cold or flu symptoms or for sleep. Be sure to check the labels for these ingredients. Ask your pharmacist if you are not sure.

Can I take an opioid pain reliever with Brilinta?

Opioid pain relievers (opioid agonists) may reduce the blood levels and beneficial effects of Brilinta (ticagrelor). Opioid pain relievers include drugs such as hydrocodone, codeine, oxycodone, morphine, and others. Opioids can delay and reduce the absorption of ticagrelor and its active metabolite possibly due to slowed gastric emptying (the stomach doesn't empty as quickly as normal).

Your doctor may be able to prescribe a different type of pain reliever that does not interact with Brilinta. You may also need a dose adjustment, more frequent monitoring, or another type of antiplatelet medication to safely use opioids for pain.

  • Although data are limited, caution is recommended when orally administered P2Y12 inhibitors like Brilinta (ticagrelor) are given with opioid agonists.
  • In one study, when 5 mg of intravenous morphine (5 mg) was given immediately prior to a 180 mg loading dose of ticagrelor, the area under the curve (AUC) of ticagrelor (and its active metabolite) were decreased by approximately 36%.

This effect can reduce the beneficial antiplatelet effects of Brilinta. In acute coronary syndrome patients who require an opioid agonist, the use of a parenteral (injectable) antiplatelet agent should be considered.

Bottom Line

  • Talk to your doctor or pharmacist about the best pain reliever to use while you are taking Brilinta. You may also be able to use non-drug pain relievers, like cold applications or rest, or topical anti-inflammatories in the case of joint pain.
  • You should also review any prescription, OTC herbal or vitamin supplements you take with a health care provider who prescribes Brilinta.
  • Do not stop using any medications without first talking to your doctor.

Brilinta (ticagrelor) is manufactured by AstraZeneca and was first approved by the FDA in July 2011.

This is not all the information you need to know about Brilinta for safe and effective use. Review the full Brilinta information here, and discuss this information and any questions with your doctor or other health care provider.

References
  • Brilinta (ticagrelor) [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2020 https://www.azpicentral.com/brilinta/brilinta.pdf
  • Kubica J, et al. Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors. Int J Cardiol 215 (2016): 201-208.

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