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I am a clinical pharmacist currently doing freelance writing on various pharmacy topics. I graduated from Arnold and Marie Schwartz School of Pharmacy in 1988 with a bachelors degree in pharmacy. While practicing as a clinical pharmacist I obtained my Doctor of Pharmacy degree (PharmD) from the University of Florida in 2003.

Wednesday, September 7, 2011

Brilinta® vs Plavix®: Which Is Better At Preventing Clots?

Brilinta® vs Plavix®: Which Is Better At Preventing Clots?
Patients are going to hear a lot of buzz about Brilinta®, a new antiplatelet drug. Brilinta® (ticagrelor) will compete with Plavix® (clopidogrel) and Effient® (prasugrel) for use in  acute coronary syndrome or after a placement of a stent in an artery of the heart. Acute coronary syndrome is chest pain and other symptoms that happen because the heart does not get enough blood. It includes unstable angina and heart attacks. Plavix® will still lead the pack for a while. It was the first one approved and is used the most. But it's not perfect. Plavix has a delayed onset and variable response because it has to be activated in the liver first before it takes effect. Effient® is more effective than Plavix®, but causes more bleeding. That's why it's not for patients with a prior stroke or transient ischemic attacks (TIA's or mini-strokes), or patients over age 75. Brilinta® seems to be more effective than Plavix®for acute coronary syndrome, and has a similar risk of major bleeding in most cases. For every 1000 patients with coronary syndrome treated for up to one year, Brilinta® prevents 11 more cardiovascular deaths (deaths relating to the heart and the blood vessels or the circulation), 11 more heart attacks, and at least 6 more stent thromboses (clots) compared to Plavix®. But these benefits are only seen with lower doses of aspirin taken along with Brilinta. Patients should take Brilinta® with 81 mg/day of aspirin. Explain that doses over 100 mg/day may reduce Brilinta's efficacy (effectiveness). Brilinta® has a faster onset of effectiveness than Plavix® or Effient®, because it's not a prodrug (does not have to be activated by the body). Brilinta® also wears off faster because it binds to platelets REVERSIBLY, instead of permanently like Plavix® and Effient®.  Both Brilinta® and Plavix® need to be stopped 5 days before surgery. Brilinta®'s short duration of action may be a disadvantage in the long run because it's taken twice a day, instead of once a day like Plavix® and Effient®. Though,  I have little doubt that they will come out with a long acting Brilinta® pill in the future, which can be taken once a day. Plavix® still should be recommended first for most patients, especially when the generic comes out  next year. Brilinta® may cause shortness of breath, especially in the first week. Patients can switch to Plavix® or Effient® if the shortness of breath is severe or persistent. 

Source: Pharmacist's Letter

6 comments:

  1. Interested to know the likelihood of retinal hemorrhage.

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  2. For which drug would you like to know the incidence of retina hemorrhage?

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  3. Can Plavix and Brilinta be taken together? And with aspirin?

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  4. Only under certain circumstances. You must convert your health care practitioner if you think you need to add anything to Brillinta. You risk having additional risk to bleeding if you do. Be very careful !!!!! Thank you for your readership.

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  5. can I take allopurinol with brillinta?

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  6. I'm sorry, but there is not nearly enough information to safely answer that question. You would have to seek out your pharmacist AND your healthcare provider to see if the two drugs are compatible for you. Many factors come into play such as types and dosed of other medications, other disease states, etc. This is especially important with Brillinta, since a side effect is bleeding - a potentially very dangerous situation. Thank you for your readership.

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