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Brilinta - instructions for use, analogs, reviews and release forms (tablets 90 mg) drugs for the treatment of thrombosis, embolism with myocardial infarction, unstable angina in adults, children and pregnancy. Composition

Brilinta - instructions for use, analogs, reviews and release forms (tablets 90 mg) drugs for the treatment of thrombosis, embolism with myocardial infarction, unstable angina in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Brilinta. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Brilinta in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues Brilinta in the presence of existing structural analogues. Use for the treatment of thrombosis, embolism with myocardial infarction, unstable angina in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

 

Brilinta antiaggregant drug.

 

Mechanism of action

 

Brilint contains ticagrelor, a representative of the chemical class of cyclopentyltriazolopyrimidines, which is a selective and reversible P2Y12 receptor antagonist of direct action and prevents ADP-mediated P2Y12-dependent activation and platelet aggregation. Ticagrelor does not prevent the binding of ADP, but its interaction with the P2Y12-receptor of platelets prevents ADP-induced signal transduction. Because platelets are involved in the initiation and / or development of thrombotic complications of atherosclerosis, it has been shown that inhibition of platelet function reduces the risk of developing cardiovascular events such as death, myocardial infarction or stroke.

 

Ticagrelor has an additional mechanism of action, increasing local concentrations of endogenous adenosine by inhibiting the endogenous equilibrium nucleoside transporter (ENT-1).

 

Adenosine is formed locally in places of hypoxia and tissue damage by release from ATP and ADP. Ticagrelor inhibits ENT-1 and prolongs T1 / 2 adenosine, thereby increasing its local extracellular concentration, enhancing the local adenosine response.Ticagrelor has no clinically significant direct effect on adenosine receptors (A1, A2A, A2B, A3) and is not metabolized to adenosine. Adenosine has the following effects, which include: vasodilation, cardioprotection, inhibition of platelet aggregation, modulation of inflammation and the occurrence of dyspnea, which may affect the clinical profile of ticagrelor. It was shown that in healthy volunteers and in patients with acute coronary syndrome (ACS) ticagrelor increased the following adenosine effects: vasodilation (estimated as an increase in coronary blood flow in healthy volunteers, headache), inhibition of platelet function (in vitro in whole human blood) and Shortness of breath. Nevertheless, the association of elevated local adenosine concentrations with clinical outcomes (morbidity and mortality) has not been proven.

 

Clinical efficacy

 

The PLATO study (PLATelet Inhibition and Patient Outcomes) involved 18,624 patients who developed symptoms of unstable angina, myocardial infarction without ST-segment elevation, or myocardial infarction with ST-segment elevation in the last 24 hours and who were treated conservatively , or by percutaneous coronary intervention (CKB), or CABG.In this study, against a background of daily therapy with acetylsalicylic acid, ticagrelor 90 mg twice daily was compared with Clopidogrel 75 mg per day for efficacy in preventing the development of a combined end point of cardiovascular death, myocardial infarction or stroke due to the effect on the incidence of cardiovascular death and myocardial infarction. The loading dose was 300 mg of clopidogrel (a dose of 600 mg was also tolerated by PCI) or 180 mg of ticagrelor.

 

The effect of ticagrelor was manifested early (at day 30, absolute risk reduction (SAR) by 0.6% and relative risk reduction (COP) by 12%), maintaining a constant effect of therapy for 12 months, leading to ATS 1.9% and COP to 16 % during a year.

 

Brilliant reduces the relative risk of a combined endpoint (a combination of cardiovascular deaths, heart attack and stroke) in patients with unstable angina, myocardial infarction without ST-segment elevation and ST-segment myocardial infarction by 16% (hazard ratio (OR) 0.84, 95% confidence interval (CI) 0.77-0.92, p = 0.0003), cardiovascular death by 21% (RR 0.79, 95% CI 0.69-0.91, p = 0.0013), myocardial infarction by 16% (RR 0.84, 95% CI 0.75 -0.95, p = 0.0045).

 

The effectiveness of Brilint's preparation is shown in different subgroups of patients, regardless of body weight, sex, history of diabetes mellitus, transient ischemic attack or non-hemorrhagic stroke, revascularization, concomitant therapy (including heparin, glycoprotein 2b / 3a receptor inhibitors, definitive diagnosis (myocardial infarction without ST-segment elevation, myocardial infarction with ST-segment elevation and unstable angina) and treatment planned for randomization (invasive or conservative).

 

Additional analysis suggested a possible association with a dose of acetylsalicylic acid; it was expressed that the reduced efficiency was observed at reception of preparation Brilinta in a combination with atsetilsalitsilovoj the acid in the raised or increased doses. The recommended dose of Acetylsalicylic acid for continuous administration in conjunction with the preparation of Brilint is 75-150 mg.

 

In the study of the Brilint drug, a statistically significant COP according to the cumulative criterion was shown: death from cardiovascular causes, myocardial infarction and stroke in patients with acute coronary syndrome that is scheduled for invasive intervention (16% COP, 1.7% 1.7%, p = 0.0025).In the exploratory analysis of the effectiveness of the Brilint drug, the primary endpoint of COP was also shown in patients with acute coronary syndrome who received conservative therapy (COP 15%, CAP 2.3%, nominal p = 0.0444). Patients after stenting with ticagrelor showed a decrease in the frequency of stent thrombosis (GFR 32%, SAR 0.6%, nominal p = 0.0123).

 

Brilint's preparation caused a statistically significant COP by 16% (2.1% CAP) for such a cumulative criterion as death from all causes, myocardial infarction and stroke.

 

COP death from all causes of taking Brilint's drug was 22% at a nominal significance level of p = 0.0003 and ATS - 1.4%.

 

Aggregate criterion for combined effectiveness and safety

 

The combined criterion of combined efficacy and safety (death from cardiovascular causes, myocardial infarction, stroke, or large bleeding as determined by the PLATO study) confirms that, within 12 months after acute coronary syndrome, the beneficial effect of ticagrelor is not neutralized by cases of large bleeding (8% ATS 1.4%, OR 0.92, p = 0.0257).

 

Pharmacokinetics

 

Ticagrelor is rapidly absorbed with an average Tmax of about 1.5 hours. The average absolute bioavailability of ticagrelor is 36%.Admission of fatty foods does not affect Cmax of ticagrelor or AUC of the active metabolite, but leads to an increase of 21% in the Ticagrelor AUC and a 22% decrease in Cmax of the active metabolite. These small changes have minimal clinical significance; so tikagrelor can be prescribed regardless of the meal.

 

Ticagrelor in the form of a suspension of crushed tablets in drinking water taken orally or injected into the stomach through a nasogastric tube is bioequivalent to ticagrelor taken internally in the form of tablets of the Brilint preparation (AUC and Cmax of ticagrelor and active metabolite in the range of 80-125%).

 

In the case of taking the suspension, the initial exposure (0.5 h and 1 h after administration) was higher than with ticagrelor in the form of Brilint's tablets, but later (from 2 h to 48 h) the concentration profile was almost the same.

 

Binding to plasma proteins of ticagrelor and its active metabolite is high (more than 99%).

 

The main way of deducing ticagrelor is through hepatic metabolism. When an isotope-labeled ticagrelor is administered, on average about 57.8% of radioactivity is excreted with feces, 26.5% in urine. The excretion of ticagrelor and active metabolite with urine is less than 1% of the dose. Basically, the active metabolite is excreted with bile.

 

Older patients (75 years and older) have a higher exposure to ticagrelor (Cmax and AUC approximately 25% higher) and an active metabolite compared to younger patients. These differences are not considered clinically significant.

 

There is no data on the use of ticagrelor in children.

 

Women have a higher exposure to ticagrelor and an active metabolite compared to men. These differences are not considered clinically significant.

 

Indications

 

In combination with acetylsalicylic acid:

  • for the prevention of atherothrombotic complications in patients with acute coronary syndrome (unstable angina, myocardial infarction without ST-segment elevation, or myocardial infarction with ST-segment elevation [STEMI]), including patients receiving drug therapy and patients undergoing percutaneous coronary intervention or aortocoronary bypass.

 

Forms of release

 

Tablets coated with a coating of 90 mg in a package of 14, 56 or 168 pcs.

 

Instructions for use and dosage

 

The drug is taken orally, regardless of food intake.

 

The use of Brilint should be started with a single loading dose of 180 mg (2 tablets of 90 mg) and then continue taking 90 mg twice a day.

 

For patients with difficulty swallowing the tablet (or 2 tablets - in case of taking a loading dose) should be ground to a fine powder, stir in 1/2 cup of drinking water and immediately drink the resulting suspension. The remainders should be mixed with additional 1/2 cup of drinking water and drink the resulting suspension. The suspension can also be administered via a nasogastric tube (CH8 or larger). After the introduction of the suspension, it is necessary to rinse the nasogastric tube with water so that the dose of the drug completely enters the patient's stomach.

 

Simultaneously, in the absence of specific contraindications, prescribe acetylsalicylic acid (from 75 mg to 150 mg with constant intake), daily.

 

It is necessary to avoid interruptions in therapy. In case of skipping Brilinta, the patient should take only one tablet of 90 mg (the next dose) at the scheduled time.

 

If necessary, patients taking clopidogrel, can be transferred to receive the drug Brilint. It is recommended to carry out Brilint's therapy for 12 months, except for cases of clinical necessity in the early cancellation of the drug.Data on the use of ticagrelor for more than 12 months are limited. In patients with acute coronary syndrome, early withdrawal of any antiplatelet therapy, including Brilint's drug, may increase the risk of cardiovascular death or myocardial infarction as a result of the underlying disease. Pretermination should be avoided.

 

Older patients do not need a dose adjustment.

 

Patients with renal insufficiency do not need a dose adjustment. There is no information on the use of Brilint in patients on hemodialysis, so its use in these patients is not shown.

 

Patients with mild hepatic insufficiency are not required to adjust the dose. There have been no studies of Brilint in patients with moderate or severe hepatic insufficiency, so the use in this category of patients is contraindicated.

 

The safety and efficacy of the Brilint drug in children and adolescents under the age of 18 have not been established in adults approved.

 

Side effect

  • hyperuricemia;
  • intracranial hemorrhage;
  • headache;
  • dizziness;
  • paresthesia;
  • confusion of consciousness;
  • hemorrhages (intraocular, conjunctival, retinal);
  • hemorrhage in the ear;
  • vertigo;
  • dyspnea;
  • nose bleed;
  • hemoptysis;
  • gastrointestinal bleeding;
  • vomiting with blood;
  • bleeding from an ulcer in the digestive tract;
  • hemorrhoidal hemorrhages;
  • gastritis;
  • bleeding in the oral cavity (including gingival hemorrhage);
  • nausea, vomiting;
  • diarrhea, constipation;
  • abdominal pain;
  • dyspepsia;
  • retroperitoneal haemorrhages;
  • subcutaneous or dermal hemorrhages;
  • bruises;
  • rash;
  • itching;
  • hemarthrosis;
  • bleeding from the urinary tract;
  • vaginal bleeding (including metrorrhagia);
  • increase in the concentration of creatinine in the blood;
  • bleeding at the site of the procedure;
  • bleeding after the procedure;
  • bleeding from a wound;
  • traumatic bleeding.

 

Contraindications

  • hypersensitivity to ticagrelor or any of the components of the drug;
  • active pathological bleeding;
  • intracranial hemorrhage in the anamnesis;
  • moderate or severe hepatic impairment;
  • joint use of ticagrelor with powerful inhibitors of CYP3A4 (eg, ketoconazole, clarithromycin, nefazodone, ritonavir and atazanavir);
  • children and adolescents under 18 years of age (due to the lack of data on efficacy and safety of use in this group of patients).

 

Application in pregnancy and lactation

 

Data on the use of Brilint in pregnant women are absent or limited. The drug Brilinta is not recommended for use during pregnancy.

 

Since it is impossible to exclude the risk for a newborn / infant, it is not recommended to use Brilint's drug during the period of breastfeeding.

 

In experimental studies on animals, ticagrelor caused a slight decrease in the weight gain in the mother, a decrease in the viability of the newborn and its body weight, and a slowdown in growth. Available pharmacodynamic, toxicological data in animals have shown that ticagrelor and its active metabolites are excreted in breast milk.

 

Use in children

 

The safety and efficacy of Brilint's drug in children and adolescents under the age of 18 according to the indications approved in adults have not been established.

 

Application in elderly patients

 

Older patients do not need a dose adjustment. Against the background of the use of the Brilint drug, an increase in the serum creatinine content is possible,therefore, renal function should be assessed in accordance with routine clinical practice, paying special attention to patients aged 75 years and older.

 

special instructions

 

Risk of bleeding

 

In patients with acute coronary syndromes treated with drug Brilinta and Aspirin had an increased risk of non-CABG major bleeding and bleeding requiring special medical attention, such as large + minor bleeding to determine the PLATO, but did not increase the risk of fatal / life-threatening bleeding.

 

When prescribing the Brilint drug, one should evaluate the relationship between the benefits of preventing atherothrombotic events and the risk in patients with an increased likelihood of bleeding.

 

In the presence of clinical indications Brilint preparation should be used with caution in the following groups of patients:

  • patients predisposed to development of bleeding (e.g., due to trauma recently obtained, the recent surgery, bleeding disorders, active or recent bleeding from the gastrointestinal tract).Use of the drug Brilinta contraindicated in patients with active pathological bleeding, intracranial hemorrhage history of moderate or severe hepatic insufficiency;
  • concomitant use of drugs that may increase the risk of bleeding (e.g., non-steroidal anti-inflammatory drugs (NSAIDs), oral anticoagulants and / or fibrinolytics taken within 24 hours prior to receiving drug Brilinta).

 

There are no data on the haemostatic efficacy of platelet transfusions with the use of Brilint preparation; Brilinta can inhibit transfused platelets in the blood. Because by the concomitant use of the drug Brilinta and Desmopressin did not decrease standardized bleeding time, it is unlikely that desmopressin will be effective to stop the bleeding.

 

Antifibrinolytic therapy (aminocaproic acid or tranexamic acid) and / or recombinant factor 7a can enhance hemostasis. After establishing the cause of bleeding and its relief, you can resume therapy with Brilint.

 

Surgical operations

 

Before the planned operation or the start of taking new drugs, the patient should inform the doctor about taking Brilint's drug.

 

In patients undergoing CABG, the incidence of major bleeding with Brilint was the same as when clopidogrel was used on all days after discontinuation of therapy, except day 1, when the incidence of major bleeding was higher with Brilint's drug.

 

If the patient undergoes a routine operation and antithrombotic effect is not desired, then Brilent's therapy should be stopped 7 days before the operation.

 

Patients at risk of developing bradycardia

 

In connection with the identification of asymptomatic pauses in a previously conducted clinical trial, patients with an increased risk of developing bradycardia (for example, patients without a pacemaker who are diagnosed with SSSU, AV cardiac block 2 or 3, syncope associated with bradycardia) are not were included in the main study to assess the safety and efficacy of the Brilint preparation. Therefore, due to the limited clinical experience of using the drug in these patients, it is recommended to prescribe with caution the preparation of Brilint to such patients.

 

Additional caution is needed when the drug is used together with drugs that can cause bradycardia. However, there were no clinically significant side effects when combined with one or more drugs that could cause bradycardia (eg, 96% beta-blockers, 33% calcium channel blockers, including diltiazem and verapamil, and 4% digoxin).

 

In the course of a sub-analysis using daily Holter ECG monitoring in the ticagrelor group compared to clopidogrel, more patients in the acute phase of acute coronary syndrome (ACS) had ventricular pauses for more than 3 seconds. An increase in the number of ventricular pauses recorded with day-to-day Holter monitoring was associated with ticagrelor more often in patients with chronic heart failure than in the general population in the acute phase of ACS, but not in the first month. Pauses in these patients were not followed by subsequent undesirable clinical consequences (fainting and pacemaker installation).

 

Dyspnea

 

Dyspnoea with the use of Brilint preparation is usually weak or moderate in intensity, often passes as the drug continues to therapy.Patients with bronchial asthma / COPD may have an increased absolute risk of dyspnea with Brilinta. In patients with bronchial asthma / COPD, ticagrelor should be used with caution. The mechanism of dyspnea with ticagrelor is not clear. If the patient develops a new episode of dyspnea, dyspnoea persists or worsens during Brilint's use, then a full examination should be performed, and in case of intolerance, the drug should be discontinued.

 

Increase in the level of creatinine

 

When taking Brilinta, the level of creatinine may increase. The mechanism of this effect is not known. Evaluation of renal function should be performed one month from the beginning of the drug, and subsequently in accordance with routine clinical practice, paying special attention to patients aged 75 years and older, patients with moderate or severe renal failure and receiving therapy with angiotensin receptor antagonists.

 

Increased uric acid levels

 

Patients receiving ticagrelor have a higher risk of hyperuricemia than with clopidogrel.Care must be taken in patients with hyperuricemia or arthritic arthritis in history. As a preventive measure, the use of ticagrelor in patients with hyperuricemic nephropathy should be avoided.

 

Other instructions

 

On the basis of the observed interaction between acetylsalicylic acid in the maintenance dose and the efficacy of ticagrelor compared to clopidogrel, the combined use of acetylsalicylic acid in a high maintenance dose (> 300 mg) and Brilint preparation is not recommended.

 

The combined use of Brilint's preparation with potent inhibitors of CYP3A4 (eg, ketoconazole, clarithromycin, nefazodone, ritonavir and atazanavir) is contraindicated. it can lead to a significant increase in the exposure of ticagrelor.

 

Joint use of the Brilint preparation with powerful inducers CYP3A4 (for example, rifampicin, phenytoin, Carbamazepine and phenobarbital) is not recommended, because their joint administration can reduce the exposure and effectiveness of ticagrelor.

 

The combined use of the Brilint preparation and CYP3A4 substrates with a narrow therapeutic index (for example, cisapride and ergot alkaloids) is not recommended, becausetikagrelor can increase the exposure of these drugs. Joint use of Brilint with Simvastatin or lovastatin in a dose of more than 40 mg is not recommended.

 

With the combined use of Digoxin and Brilint preparation, thorough clinical and laboratory monitoring (heart rate, and in the presence of clinical indications also ECG and digoxin concentration in the blood) is recommended.

 

There is no evidence of a co-administration of ticagrelor with potent P-glycoprotein inhibitors (eg, Verapamil and quinidine), which can increase the exposure of ticagrelor. If this combination can not be avoided, then treatment should be conducted with caution.

 

Impact on the ability to drive vehicles and manage mechanisms

 

There have been no studies of the effect of Brilint's preparation on the ability to drive vehicles and control mechanisms. Brilint does not influence or negatively affect the ability to drive vehicles and machinery. During the treatment of acute coronary syndrome, dizziness and confusion were reported. If these phenomena develop, patients should be careful when driving and other mechanisms.

 

Drug Interactions

 

The impact of other drugs on Brilint's drug

 

Drugs metabolized by the isoenzyme CYP3A4

 

Inhibitors of CYP3A4. Powerful inhibitors of CYP3A4: the combined use of Ketoconazole with ticagrelor increases Cmax and AUC of ticagrelor in 2.4 and 7.3 times, respectively. Cmax and AUC of the active metabolite are reduced by 89% and 56%, respectively. Other potent inhibitors of CYP3A4 (clarithromycin, nefazodone, ritonavir and atazanavir) will have the same effects, so their combined use with Brilint is contraindicated.

 

Moderate inhibitors of CYP3A4: the combined use of diltiazem with ticagrelor increases Cmax of ticagrelor by 69%, and AUC by 2.7 times, while decreases Cmax of active metabolite by 38%, and AUC does not change. Ticagrelor does not affect the plasma concentrations of diltiazem. Other moderate inhibitors of CYP3A4 (eg, amprenavir, aprepitant, erythromycin, fluconazole) can be given concomitantly with Brilint's preparation.

 

Ciclosporin (inhibitor of P-gp and CYP3A4). Co-administration of cyclosporine (600 mg dose) with ticagrelor increases Cmax and Ticagrelor AUC 2.3 and 2.8 times, respectively. At the same time there is an increase in the active metabolite AUC by 32% and a decrease in Cmax by 15%.Ticagrelor does not affect the plasma concentration of cyclosporine.

 

Inductors CYP3A4. Joint use of rifampicin with ticagrelor reduces Cmax and AUC of ticagrelor by 73% and 86%, respectively. The active metabolite does not change, and the AUC decreases by 46%. Other inducers of CYP3A4 (e.g., phenytoin, Phenobarbital and carbamazepine), apparently would reduce exposure Brilinta preparation. Powerful inducers of CYP3A4 can reduce the exposure and effectiveness of Brilint's preparation.

 

Other drugs. According to the results of the pharmacological studies of the interaction ticagrelor concomitant use of heparin, enoxaparin and acetylsalicylic acid or desmopressin did not affect the pharmacokinetics of ticagrelor, its active metabolite, and ADP-dependent platelet aggregation. If there are clinical indications for prescribing drugs that affect hemostasis, they should be used with caution in combination with the Brilint drug.

 

No data on the joint use of the drug with Brilinta potent inhibitors of P-glycoprotein (e.g., quinidine and verapamil) which are capable of increasing the exposure ticagrelor.If joint use is not possible, then combined therapy should be conducted with caution.

 

Effect of Brilint drug on other drugs

 

Drugs metabolized by the isoenzyme CYP3A4

 

Simvastatin: concomitant use of ticagrelor and simvastatin increases Cmax and AUC of simvastatin by 81% and 56%, respectively; Cmax and AUC of simvastatin acid increase by 64% and 52%, respectively, while in some cases these rates increase by 2-3 times. Joint use of simvastatin at a dose above 40 mg / day with ticagrelor may lead to side effects of simvastatin. Therefore, if this combination is necessary, the relationship between the potential risk and benefit of therapy should be assessed. It is not recommended to use Brilint together with simvastatin and lovastatin in a dose exceeding 40 mg.

 

Atorvastatin: concomitant use of Atorvastatin and ticagrelor increases Cmax and AUC of atorvastatin acid metabolites by 23% and 36%, respectively. A similar increase in Cmax and AUC values ​​is observed for all atorvastatin acid metabolites. These changes are recognized clinically insignificant.

 

Similar effects with statins metabolized by CYP3A4 can not be ruled out. In the PLATO study, 93% of patients in the ticagrelor and different statin group did not have any undesirable symptoms related to statin safety.

 

Ticagrelor is a moderate inhibitor of CYP3A4. The combined use of the Brilint preparation and CYP3A4 substrates with a narrow therapeutic index (eg, cisapride or ergot alkaloids) is not recommended, because tikagrelor can increase the exposure of these drugs.

 

Drugs metabolized by the isoenzyme CYP2C9

 

With the simultaneous use of ticagrelor and tolbutamide, plasma concentrations of none of these drugs were changed. This suggests that ticagrelor is not an inhibitor of the CYP2C9 isoenzyme, and it is unlikely that it affects the CYP2C9-mediated metabolism of drugs like Warfarin and tolbutamide.

 

Oral contraceptives

 

The combined use of ticagrelor, levonorgestrel and ethinylestradiol increases the exposure of ethinyl estradiol by about 20%, but does not affect the pharmacokinetics of levonorgestrel. No clinically significant effect on contraceptive effectiveness is expected with simultaneous use of levonorgestrel, ethinylestradiol, and Brilint's drug.

 

Substrate P-gp (including digoxin and cyclosporin)

 

The concomitant use of digoxin with ticagrelor increases Cmax and AUC of digoxin by 75% and 28%, respectively. When administered together with ticagrelor on average, Cmin digoxin increased by 30%, in some cases - by 2 times. Stax and AUC of ticagrelor with the use of digoxin did not change. Therefore, it is recommended that appropriate clinical and / or laboratory monitoring be carried out while using Brilint and P-gp-dependent drugs with a narrow therapeutic index, such as digoxin and cyclosporine.

 

Other concomitant therapy

 

With the joint use of the drug Brilinta with drugs that can cause bradycardia, you should be careful. However, PLATO did not observe clinically significant adverse events when combined with one or more drugs capable of causing bradycardia (eg, 96% beta-blockers, 33% calcium antagonists, including diltiazem and verapamil, and 4% digoxin).

 

In the PLATO study, Brilint's preparation was predominantly administered together with acetylsalicylic acid, proton pump inhibitors, statins, beta-blockers,ACE inhibitors and angiotensin receptor antagonists in a long-term administration, as well as with heparin, low molecular weight heparins, glycoprotein 2b / 3a receptor inhibitors for intravenous administration as part of short-term therapy. According to the results of these studies, there was no clinically significant undesirable interaction.

 

The combined use of the Brilint preparation with heparin, enoxaparin or desmopressin did not affect APTT, activated clotting time (ABC), and factor 10a, but due to potential pharmacodynamic interaction, caution should be exercised when combined with preparations that affect haemostasis.

 

In connection with reports of subcutaneous hemorrhages against the background of the use of selective serotonin reuptake inhibitors (eg, paroxetine, sertraline and citalopram), caution should be exercised when they are taken together with the Brilint drug.

 

With the daily use of grapefruit juice in large volumes (200 ml 3 times a day), a two-fold increase in the exposure of ticagrelor was observed.It is expected that such an increase in ticagrelor exposure is not clinically important for most patients.

 

Analogues of the Brilint drug

 

Structural analogs for the active substance:

  • Tikagrelor.

 

Analogues on the curative effect (agents for the treatment and prevention of thrombosis and embolism):

  • Aveliesin Brown;
  • Agrenoks;
  • Actylase;
  • AngioNorm;
  • Aspizol;
  • Aspirin Cardio;
  • Acenocoumarol;
  • Acetylsalicylic acid;
  • Bufferin;
  • Warfarin;
  • Vinpocetine;
  • Heparin;
  • Detromb;
  • Dipyridamole;
  • Zilt;
  • Calciparin;
  • Cardiomagnet;
  • Carinate;
  • Karinat Forte;
  • Clexan;
  • Cleaver;
  • Clopidex;
  • Clopidogrel;
  • Collorite;
  • Complymine;
  • Coplawix;
  • Xantinol nicotinate;
  • Xarelto;
  • Courantil;
  • Lapal;
  • Listab;
  • Myristin;
  • Parsedil;
  • Pelentan;
  • Pentoxifylline;
  • Plavix;
  • Plolidol 100;
  • Ralofect;
  • Reogluman;
  • Reopoliglyukin;
  • Ribasan forte;
  • Cincumar;
  • Streptase;
  • Tagren;
  • Tyclid;
  • Ticlo;
  • Trombo ACC;
  • Thrombopol;
  • Troparin;
  • Ukidan;
  • Phenylin;
  • Phlogenzyme;
  • Cibor;
  • Egitromb.

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