Brilinta Dosage/Direction for Use

Posology: 60 mg: History of Myocardial Infarction (at least one year ago): Patients taking Brilinta should also take a daily low maintenance dose of ASA 75-150 mg, unless specifically contraindicated.
Brilinta 60 mg twice daily is the recommended dose when an extended treatment is required for patients with a history of MI of at least one year and a high risk of an atherothrombotic event (see "Pharmacology: Pharmacodynamics under Actions"). Treatment may be started without interruption as continuation therapy after the initial one-year treatment with Brilinta 90 mg or other adenosine diphosphate (ADP) receptor inhibitor therapy in ACS patients with a high risk of an atherothrombotic event. Treatment can also be initiated up to 2 years from the MI, or within one year after stopping previous ADP receptor inhibitor treatment. There are limited data on the efficacy and safety of Brilinta beyond 3 years of extended treatment.
If a switch is needed, the first dose of Brilinta should be administered 24 hours following the last dose of the other antiplatelet medication.
Patients with Coronary Artery Disease (CAD) and Type 2 Diabetes Mellitus (DM) with a history of percutaneous coronary intervention (PCI): Brilinta 60 mg twice daily is recommended dose for patients with CAD and type 2 DM with a history of PCI with no prior MI. No loading dose of Brilinta is required.
Patient may start treatment with Brilinta 60 mg twice daily, regardless of their previous antiplatelet regimen.
Treatment with Brilinta should be continued in patients with CAD and type 2 DM for as long as the patient remains at high risk of an atherothrombotic events and low risk of bleeding, for a duration up to three years. Efficacy and safety data are insufficient to establish whether the benefits of Brilinta still outweigh the risks after three years of treatment (see "Precautions" and "Pharmacology: Pharmacodynamics under Actions").
If a switch is needed, the first dose of Brilinta should be administered 24 hours following the last dose of the other antiplatelet medication.
90 mg: Acute Coronary Syndrome or a History of Myocardial Infarction: Brilinta treatment should be initiated with a single 180 mg loading dose (two tablets of 90 mg) and then continued at 90 mg twice daily.
Patients taking Brilinta should also take ASA daily, unless specifically contraindicated. Following an initial dose of ASA, Brilinta should be used with a maintenance dose of ASA of 75-150 mg (see "Pharmacology: Pharmacodynamics under Actions").
Treatment is recommended for up to 12 months unless discontinuation of Brilinta is clinically indicated (see "Pharmacology: Pharmacodynamics under Actions"). Experience beyond 12 months is limited.
In patients with Acute Coronary Syndromes (ACS), premature discontinuation with any antiplatelet therapy, including Brilinta, could result in an increased risk of cardiovascular (CV) death, myocardial infarction (MI) or stroke due to the patient's underlying disease. Therefore, premature discontinuation of treatment should be avoided.
In patients having an ACS event, the loading dose of 180 mg should be given as soon as possible regardless of any previous antiplatelet treatment.
Acute Ischemic Stroke or Transient Ischemic Attack (TIA): Initiate treatment with a 180 mg loading dose of Brilinta and then continue with 90 mg twice daily for up to 30 days. The treatment effect accrued early in the course of therapy (see "Pharmacology: Pharmacodynamics under Actions").
Use Brilinta with a loading dose of ASA (300 to 325 mg) and a daily maintenance dose of ASA of 75 to 100 mg (see "Precautions" and "Pharmacology: Pharmacodynamics under Actions").
Physicians who, desire to switch patients, with a prior ACS event, to Brilinta should administer the first dose of Brilinta 24 hours following the last dose of the other antiplatelet medication.
Missed dose: Lapses in therapy should also be avoided. A patient who misses a dose of Brilinta should take only one tablet (their next dose) at its scheduled time.
Special Populations: Elderly: No dose adjustment is required in elderly (see "Pharmacology: Pharmacokinetics under Actions").
Renal impairment: No dose adjustment is necessary for patients with renal impairment (see "Pharmacology: Pharmacokinetics under Actions").
Hepatic impairment: Ticagrelor has not been studied in patients with severe hepatic impairment and its use in these patients is therefore contraindicated (see "Contraindications"). Only limited information is available in patients with moderate hepatic impairment. Dose adjustment is not recommended, but ticagrelor should be used with caution (see "Precautions" and "Pharmacology: Pharmacokinetics under Actions"). No dose adjustment is necessary for patients with mild hepatic impairment (see "Pharmacology: Pharmacokinetics under Actions").
Paediatric population: The safety and efficacy of ticagrelor in children below the age of 18 years have not been established. No data are available.
60 mg: There is no relevant use of ticagrelor in children with sickle cell disease (see "Pharmacology: Pharmacodynamics and Pharmacokinetics under Actions").
Method of administration: For oral use. Brilinta can be taken with or without food. For patients who are unable to swallow the tablet(s) whole, the tablets can be crushed to a fine powder and mixed in half a glass of water and drunk immediately. The glass should be rinsed with a further half glass of water and the contents drunk. The mixture can also be administered via a nasogastric tube (CH8 or greater). It is important to flush the nasogastric tube through with water after administration of the mixture.