Brilinta (Ticagrelor) vs. Plavix (Clopidogrel): Which Is Better?

Medically reviewed by Femi Aremu, PharmD

Brilinta (ticagrelor) and Plavix (clopidogrel) are blood-thinning medications, also called blood thinners. Heart doctors (cardiologists) often prescribe blood thinners to help prevent blood clotting and reduce the risk of heart-related events, such as a heart attack or stroke.

As antiplatelet drugs, Brilinta and Plavix work by blocking the P2Y12 receptor in your body. This receptor helps small blood cells called platelets stick together to form clots. By blocking the P2Y12 receptor, Brilinta and Plavix prevent blood clots.

Brilinta is generally considered more effective than Plavix. However, there are several important factors to consider when selecting the right treatment.

This article will discuss the similarities and differences between Brilinta and Plavix.

Uses of Plavix vs. Brilinta

Plavix and Brilinta are often taken to prevent or reduce problems associated with the heart and blood vessels, such as a heart attack or stroke, in people with:

• Acute coronary syndrome (blockage of blood flow to the heart)

• A history of heart attacks (myocardial infarctions) or strokes

• Recent percutaneous coronary intervention (PCI), also called angioplasty (a nonsurgical procedure that opens up blocked heart vessels with a thin tube), to prevent blood clots from forming after a stent placement (stent thrombosis)

The two medications work in similar ways. They both block the P2Y12 receptor to keep platelets from forming blood clots in the body.

Your healthcare provider may also advise taking a daily low-dose aspirin along with your prescription treatment to further reduce the risk of blood clotting.

What Is Acute Coronary Syndrome?

A blockage in the heart happens quickly and is often the result of a blood clot. This clot can happen suddenly, especially if there's a break in fatty material called plaque, which becomes attached to the artery walls.

If a piece of the clot breaks off, it can block one of the heart's coronary arteries, leading to a problem called acute coronary syndrome (ACS). This blockage needs immediate medical attention.

Symptoms of ACS include:

• Chest pain

• Pain in your arms, neck, and back

• Difficulty breathing

What Is a Myocardial Infarction?

A myocardial infarction, or heart attack, is a type of ACS. A heart attack occurs due to a clogged artery in the heart. If the blockage isn't fixed, that part of the heart will become damaged or start to die due to a lack of oxygen.

What Is a Percutaneous Coronary Intervention?

A percutaneous coronary intervention (PCI) is a specific heart procedure that places a metal or plastic tube (called a stent) to help open up blocked heart vessels. When this tube is holding the heart vessels open, blood can get to where it needs to go.

Which Is More Effective?

Brilinta is stronger and works faster than Plavix. This is because Plavix doesn't work until your liver breaks it down and activates the drug using a certain enzyme (protein).

Because Plavix requires this activation, it takes longer to start working. Brilinta, on the other hand, works on its own without your body having to activate it. Because Brilinta doesn't need activation in the body to work, it's often a better option for those who have a low level of the liver enzyme types Plavix needs.

Though Brilinta is considered more effective than Plavix, it's also more likely to cause bleeding. For this reason, many healthcare providers may prescribe Plavix first because it's still an effective medication with fewer bleeding risks. Plavix is also more affordable than Brilinta because it has a generic version available.

Safety Warnings and Risks

Plavix and Brilinta both come with safety warnings and risks. It's also important to know about possible interactions with other drugs to avoid harm.

Brilinta poses a higher risk of bleeding than Plavix does. You should not:

• Take Brilinta if you have active bleeding problems (e.g., ulcers) or a history of intracranial hemorrhaging

• Start Brilinta if you are undergoing urgent coronary artery bypass surgery

• If possible, stop taking Brilinta immediately if bleeding does occur

• Take doses of aspirin above 100 milligrams (mg) with Brilinta

However, Plavix can also increase the risk of bleeding. When taking antiplatelet drugs, it is generally recommended to stop your medication five days before a planned surgery that poses a major risk of bleeding.

Your healthcare provider will weigh these risks when deciding to prescribe these medications.

Drug Interactions

It's also important to know about possible interactions with other drugs to avoid harm.

Both Plavix and Brilinta can cause problems when they interact with strong blood-thinning drugs like warfarin or heparin. If you take them together, bleeding can become much more likely, so make sure your healthcare provider is aware of all the medications you're taking.

However, Plavix and Brilinta also have some different drug interactions.

Brilinta can interact with the following:

• Strong CYP3A inhibitor drugs, such as Sporanox (itraconazole) and Norvir (ritonavir). Ask your healthcare provider if you are unsure whether you take a strong CYP3A inhibitor.

• Strong CYP3A4 inducer drugs, such as Dilantin (phenytoin) and Tegretol (carbamazepine). Ask your healthcare provider if you are unsure if you take a strong CYP3A inducer.

• Certain statins, such as simvastatin and lovastatin

• Digoxin

Plavix can interact with the following:

• Certain stomach medications, like Prilosec (omeprazole) and Nexium (esomeprazole)

• Rifampin

• Opioids

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen)

• Drugs used to treat depression, known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Repaglinide, a diabetes medication

Side Effects

Like most medications, Brilinta and Plavix can cause side effects when taken. These side effects may be mild or serious, so it's important to be aware and know what to expect.

The most common side effect of Plavix and Brilinta is the increased risk of bleeding. This can take the form of nosebleeds, bruising, or bleeding that takes longer to stop. In some cases, this can be more serious (e.g., internal bleeding or bleeding in the stomach).

Other side effects of Plavix include:

• Upset stomach

• Liver problems

• Rash

• Diarrhea

Other side effects of Brilinta include:

• Difficulty breathing (shortness of breath)

• Slow heartbeat (bradycardia)

• Liver problems

It's important to remember that not everyone will experience these side effects, and some may have different reactions. If you are taking Plavix or Brilinta and notice any unusual or severe side effects, contact your healthcare provider right away.

Dosage: How to Take Plavix and Brilinta

Summary

Both Plavix and Brilinta have similar uses but can have different side effects, dosing guidelines, and drug interactions.

Though Brilinta prevents blood from clotting more effectively, it also tends to have an increased risk of side effects compared to Plavix, such as a higher chance of bleeding. Brilinta and Plavix are also slightly different in that Plavix is activated in the body after a certain type of liver enzyme breaks it down. If you have low levels of this enzyme, Brilinta might be a better option.

Make sure you discuss any concerns with your healthcare provider. They will prescribe the medication they believe will suit you best based on your condition and medical history.

Read the original article on Verywell Health.