Ticagrelor is an antiplatelet medicine, or blood thinner. It makes your blood flow through your veins more easily. This means your blood will be less likely to make a dangerous blood clot.

Taking ticagrelor can help prevent blood clots if you have an increased risk of having them.

Your risk is higher if you have:

• unstable angina
• had a heart attack

Ticagrelor is only available on prescription. It comes as tablets or melt in the mouth tablets.

• It's usual to take ticagrelor twice a day.
• Ticagrelor is often prescribed together with low dose aspirin.
• The most common side effects of ticagrelor are getting out of breath and bleeding more easily than normal. You may have nosebleeds, heavier periods, bleeding gums and bruising.
• You can drink alcohol with ticagrelor. But do not drink too much while taking this medicine. It can irritate your stomach.
• Ticagrelor is also called by the brand name Brilique.

Ticagrelor can be taken by adults aged 18 and over.

Ticagrelor isn't suitable for some people. To make sure this medicine is safe for you, tell your doctor if you:

• have had an allergic reaction to ticagrelor or any other medicines in the past
• have any injuries that are currently bleeding a lot, such as a wound
• have a stomach ulcer
• have breathing difficulties, such as asthma or COPD
• have an abnormal heart rate (arrhythmia)
• have previously had a stroke caused by bleeding in the brain
• have gout or high levels of a chemical called uric acid in your body
• have liver problems
• are trying to get pregnant, already pregnant or breastfeeding

When you start taking ticagrelor, you'll take 1 dose on your first day.

After this, most people take ticagrelor twice a day, usually once in the morning and once in the evening.

You can take ticagrelor with or without food.

If you're taking melt in the mouth tablets, put the tablet on your tongue and let it dissolve. You can then swallow it with or without water.

How much to take and how long for

Ticagrelor comes as 90mg tablets. It's also available as 60mg tablets for people who need a lower dose.

On your first day of treatment, your pharmacist will give you two 90mg tablets to take at the same time. After this, the usual dose is 90mg twice a day for 12 months.

If you have had a heart attack, your doctor may advise you to keep on taking ticagrelor after you have finished the 12-month course of treatment.

You'll usually take a lower dose of 60mg, twice a day, for up to 3 years.

What if I forget to take it?

If you forget to take ticagrelor, take it as soon as you remember. If it's nearly time for your next dose, skip the missed dose.

Do not take a double dose to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you're worried, contact your doctor or pharmacist.

What if I take too much?

Accidentally taking 1 or 2 extra tablets is unlikely to harm you.

But the amount of ticagrelor that can lead to overdose is different for everyone.

Contact your doctor straight away if you have taken some extra tablets and notice any signs of bleeding.

Like all medicines, ticagrelor can cause side effects, although not everyone gets them.

Common side effects

These common side effects happen in more than 1 in 100 people.

Talk to your doctor or pharmacist if these side effects bother you or don't go away:

• bleeding more easily than normal - nosebleeds, bruising or bleeding that takes longer to stop
• unexpected shortness of breath while resting - this can sometimes happen in the first few weeks of taking ticagrelor and is usually mild
• pain and swelling in your joints - these can be signs of gout (this is because ticagrelor can lead to high levels of uric acid in your blood)
• headaches
• dizziness
• feeling sick or indigestion
• diarrhoea or constipation
• mild rash

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Tell a doctor straight away if you:

• are coughing up blood, or there's blood in your pee, poo or vomit - this needs to be checked out as these are signs of internal bleeding
• get weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight - these can be signs of a stroke

If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.

Serious allergic reaction

In rare cases, ticagrelor can cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of ticagrelor. For a full list, see the leaflet inside your medicines packet.

• bleeding more easily than normal - be careful when doing activities that might cause an injury or a cut. Always wear a helmet when cycling. Wear gloves when you use sharp objects like scissors, knives, and gardening tools. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth. See a doctor if you're worried about any bleeding.
• shortness of breath - try breathing in slowly through your nose and out through your mouth. Sitting on a chair and leaning your chest slightly forward may also help. Your breathing will usually return to normal within a few weeks of starting ticagrelor. Tell your doctor if your symptoms don't improve or get worse. Shortness of breath can also be a sign of an ongoing or worsening heart problem.
• pain and swelling in your joints - if you get unusual muscle pain, weakness or tiredness which isn't from exercise or hard work, talk to your doctor. You may need a blood test to check what might be causing it.
• headaches - make sure you rest and drink plenty of fluids, but do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. If your headaches last longer than a week or are severe, talk to your doctor.
• dizziness - if ticagrelor makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. Do not drive or use any tools or machinery if you're dizzy, have muscle cramps or muscle pain, or are feeling a bit shaky.
• feeling sick or indigestion - try taking your tablets with a meal or snack, or shortly after eating. It may also help if you avoid eating rich or spicy food. If you have indigestion that doesn't go away, it could be a sign that you have a stomach ulcer. Talk to your doctor - they may prescribe something to protect your stomach or switch you to a different medicine.
• diarrhoea or constipation - drink plenty of water or other fluids if you have diarrhoea. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. If you have constipation, get more fibre into your diet, such as fresh fruit, vegetables and cereals, and drink plenty of water. Try to exercise, for example, by going for a daily walk or run. If this doesn't help, talk to your pharmacist or doctor.
• mild rash - it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

Ticagrelor isn't recommended during pregnancy or if you're trying to get pregnant.

To avoid getting pregnant, make sure you use contraception while you're taking ticagrelor.

But if you're trying to get pregnant, talk to your doctor, who may be able to recommend a medicine more suitable for you.

If you're breastfeeding, talk to your doctor before taking ticagrelor.

Your doctor will be able to explain the benefits and risks of taking ticagrelor while breastfeeding, and will recommend the most suitable treatment for you and your baby.

Some medicines interfere with the way ticagrelor works.

Tell your doctor if you're taking these medicines before you start taking ticagrelor:

• medicines to thin blood or prevent blood clots, such as aspirin and warfarin
• rivaroxaban or apixaban
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as citalopram
• some antibiotics, such as clarithromycin and rifampicin
• medicines for epilepsy, such as phenytoin and carbamazepine
• statins, such as simvastatin, used to lower cholesterol
• digoxin for heart problems

Taking ticagrelor with everyday painkillers

Your doctor may prescribe low dose aspirin (75mg tablets) to take together with ticagrelor.

Do not take aspirin for pain relief (300mg tablets) or ibuprofen while you're taking ticagrelor, unless a doctor has said it's OK to. They increase the chance of bleeding.

You can take paracetamol together with ticagrelor.

Mixing ticagrelor with herbal remedies and supplements

There might be a problem with taking some herbal remedies and supplements with ticagrelor, especially ones that can affect your blood (for example, ginkgo).

St John's wort (used for depression) can reduce the levels of ticagrelor in your blood. This may stop ticagrelor from working properly and increase your chances of getting a blood clot.