Brilinta vs Plavix: what’s the difference?
Prevention and treatment of blood clots in patients with ACS (acute coronary syndrome) includes the use of different types of medications. Two drugs that are commonly used, include Brilinta, brand name for ticagrelor, and Plavix brand name for clopidrogel. Both medications are antiplatelet medications used to reduce the risk of blood clots, with certain differences. Following subsections offer detailed information about both the drugs, and also offers answers to the question – Brilinta vs Plavix: what’s the difference? Before looking at the differences, here is a quick look at the condition treated by the drugs. ACS refers to a group of heart conditions that occur when the blood supply to the heart is reduced or blocked. This includes conditions such as unstable angina and heart attack.
Use of Brilinta and Plavix
Brilinta is typically used in combination with aspirin, another antiplatelet medication, to reduce the risk of future heart-related events in people who have had an ACS event. It is also used to reduce the risk of stroke and heart attack in people with a history of heart attack or severe blockages in their blood vessels, who have undergone a procedure to improve blood flow such as angioplasty or stent placement.
Plavix is used to prevent blood clots in people with certain heart and blood vessel conditions, for patients who have had a recent heart attack, stroke, or individuals with unstable angina. It is also be used to reduce the risk of blood clots in people with peripheral artery disease (PAD), which refers to a narrowing or blockage of blood vessels in the legs.
Mechanism of action of Brilinta vs Plavix
Here is a quick look at the mechanisms of action of Brilinta and Plavix to help understand the differences in outcomes better.
Brilinta as a selective and reversible P2Y12 receptor antagonist, inhibits platelet aggregation. It binds to the P2Y12 receptor, involved in ADP-mediated platelet activation, and prevents the activation and aggregation of platelets, thereby reducing the risk of blood clots.
Plavix as a prodrug is converted to its active metabolite by the liver. The active metabolite then irreversibly binds to the P2Y12 receptor on the surface of blood platelets, and inhibits platelet activation and aggregation, thereby reducing the risk of blood clots.
Both Brilinta and Plavix work by blocking the P2Y12 receptor on blood platelets to prevent their activation and aggregation, and ultimately reduce the risk of blood clots. The difference between the two is that Brilinta is a reversible antagonist while Plavix is an irreversible antagonist of the P2Y12 receptor.
Side effects of Brilinta and side effects of Plavix
Here is a short comparison of the side effects of Brilinta and Plavix.
Some patients may experience the following possible side effects of Brilinta
- Bleeding, including nosebleeds, bruising, and heavy menstrual periods
- Shortness of breath or difficulty breathing
- Headache
- Dizziness
- Nausea
- Diarrhea
- Rash or itching
- Increased levels of uric acid in the blood
In addition to the above, there is also the possibility of rare, serious side effects of Brilinta, listed below:
- Severe bleeding
- Heart rhythm problems, such as an irregular heartbeat or a slow heart rate
- Shortness of breath or difficulty breathing
Some patients may experience the following possible side effects of Plavix
- Bleeding, including nosebleeds, bruising, and heavy menstrual periods
- Diarrhea
- Stomach pain or indigestion
- Headache
- Dizziness
- Rash or itching
Similar to Brilinta, there is the possibility of rare and serious side effects of Plavix, as listed here:
- Severe bleeding
- Allergic reactions, including swelling of the face, lips, tongue or throat
- TTP (thrombotic thrombocytopenic purpura), a rare but serious blood disorder that causes blood clots to form in small blood vessels throughout the body
Drug interactions of Brilinta
The drug may interact with the following categories of drugs.
- Strong CYP3A4 inhibitors, such as ketoconazole, clarithromycin, and grapefruit juice, may increase the blood levels of ticagrelor, increasing the risk of side effects, including bleeding.
- Strong CYP3A4 inducers, such as rifampin and carbamazepine, may decrease the blood levels of ticagrelor, reducing its effectiveness.
- Other medications that affect blood clotting, such as other antiplatelet medications or anticoagulants, may increase the risk of bleeding.
Drug interactions of Plavix
The drug may interact with the following types of medications.
- Aspirin with Plavix can increase the risk of bleeding.
- NSAIDs, such as ibuprofen and naproxen, can also increase the risk of bleeding when taken with Plavix.
- Plavix with other blood-thinning medications such as heparin or warfarin can also increase the risk of bleeding.
- Some PPIs, such as omeprazole, can reduce the effectiveness of Plavix.
- Drugs that inhibit the enzyme CYP2C19 can reduce the effectiveness of Plavix. Examples include certain antidepressants, antifungal medications, and proton pump inhibitors.
- Some selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, can increase the risk of bleeding when taken with Plavix.
- Drugs that induce or inhibit the enzyme CYP3A4 can affect the metabolism of Plavix. Examples include certain antibiotics, antifungal medications, and grapefruit juice.
Ideal dosage of Brilinta and Plavix
The recommended initial dosage for Brilinta is 180 mg taken orally as a loading dose, followed by 90 mg twice daily. After the first year, the recommended maintenance dosage is 60 mg twice daily.
The recommended dosage for Plavix is 75 mg once daily. For patients with acute coronary syndrome, a loading dose of 300 mg may be given initially.
Brilinta vs Plavix: what’s the difference?
Both drugs are antiplatelet medications to prevent blood clots, and both work by preventing blood platelets from sticking together. However, there are differences between Brilinta and Plavix, as listed below:
- Mechanism of action: Brilinta and Plavix have different mechanisms of action. Brilinta is a P2Y12 inhibitor – it blocks a specific receptor on the surface of blood platelets to prevent platelet aggregation. Plavix is also a P2Y12 inhibitor, but it irreversibly binds to the receptor, unlike Brilinta which is a reversible inhibitor.
- Dosage: Brilinta is typically taken twice a day, while Plavix is usually taken once a day.
- Onset of action: Brilinta has a more rapid onset of action than Plavix. Brilinta reaches peak blood concentrations within 2 hours after ingestion, while Plavix takes about 6 hours.
- Duration of action: Brilinta has a shorter duration of action than Plavix. Brilinta’s effects last for about 12 hours, while Plavix’s effects can last for up to 5 days.
- Side effects: Both medications can cause similar side effects, such as bleeding, bruising, and upset stomach. However, Brilinta can also cause shortness of breath and a slower heart rate, while Plavix can cause diarrhea and a rash.