Ticagrelor Drug Interactions You Need to Know About

Ticagrelor (brand name Brilinta) is an antiplatelet medication that prevents blood clots in people with heart disease and stroke. While it's highly effective, Ticagrelor interacts with a number of other medications, supplements, and even certain foods. Some interactions are dangerous. Others just require monitoring.

This guide covers the most important Ticagrelor drug interactions so you know what to avoid and what to discuss with your doctor.

How Drug Interactions Work with Ticagrelor

Ticagrelor is processed by your liver through an enzyme system called CYP3A4. Medications that speed up or slow down this enzyme can change how much Ticagrelor is in your bloodstream — too much increases bleeding risk, too little means the drug won't protect you properly.

Ticagrelor also affects how your body processes certain other drugs, which means taking Ticagrelor can raise the levels of some medications in your blood.

Medications That Interact with Ticagrelor

Major Interactions (Contraindicated or Avoid)

These combinations are dangerous and should generally be avoided:

• Strong CYP3A4 inhibitors — Ketoconazole (Nizoral), Itraconazole (Sporanox), Clarithromycin (Biaxin), and Ritonavir (Norvir) are contraindicated with Ticagrelor. These drugs dramatically increase Ticagrelor levels in your blood, raising the risk of life-threatening bleeding.
• Strong CYP3A4 inducers — Rifampin (Rifadin), Phenytoin (Dilantin), Carbamazepine (Tegretol), and Phenobarbital substantially decrease Ticagrelor levels, potentially making it ineffective at preventing blood clots.
• Aspirin above 100 mg/day — This is an FDA boxed warning. Maintenance aspirin doses above 100 mg daily reduce Ticagrelor's effectiveness. Always use 75–100 mg aspirin daily with Ticagrelor, not more.
• Other anticoagulants — Combining Ticagrelor with blood thinners like Warfarin (Coumadin), Apixaban (Eliquis), Rivaroxaban (Xarelto), or Heparin significantly increases bleeding risk. If your doctor prescribes both, close monitoring is essential.

Moderate Interactions (Use with Caution)

• Simvastatin (Zocor) and Lovastatin (Mevacor) — Ticagrelor increases levels of these cholesterol medications. Do not exceed Simvastatin 40 mg/day while taking Ticagrelor. Your doctor may choose a different statin like Atorvastatin (Lipitor) or Rosuvastatin (Crestor) instead.
• Digoxin (Lanoxin) — Ticagrelor can increase Digoxin levels. Your doctor should monitor your Digoxin blood levels more frequently.
• Moderate CYP3A4 inhibitors — Diltiazem (Cardizem) and Erythromycin may increase Ticagrelor levels moderately. No dose change is required, but your doctor should be aware.
• NSAIDs — Ibuprofen (Advil, Motrin) and Naproxen (Aleve) increase bleeding risk when taken with Ticagrelor. Use Acetaminophen (Tylenol) for pain instead.
• SSRIs and SNRIs — Antidepressants like Sertraline (Zoloft), Fluoxetine (Prozac), Venlafaxine (Effexor), and Duloxetine (Cymbalta) can increase bleeding risk. This doesn't mean you can't take them together, but your doctor should know.

Supplements and OTC Medications to Watch

Some over-the-counter products and supplements interact with Ticagrelor:

• St. John's Wort — This herbal supplement is a strong CYP3A4 inducer that can significantly reduce Ticagrelor levels. Avoid it entirely.
• Fish oil / Omega-3 supplements — May have a mild blood-thinning effect. Not dangerous alone, but discuss with your doctor.
• Vitamin E (high doses) — Can increase bleeding tendency. Stick to standard multivitamin doses.
• Ginkgo biloba — Has antiplatelet properties and may increase bleeding risk. Avoid while on Ticagrelor.
• NSAIDs (Ibuprofen, Naproxen, Aspirin products) — Many cold medicines and pain relievers contain hidden NSAIDs or aspirin. Always read labels carefully and use Acetaminophen instead.

Food and Drink Interactions

• Grapefruit and grapefruit juice — Grapefruit inhibits CYP3A4 and can increase Ticagrelor levels. An occasional small glass is unlikely to cause problems, but avoid consuming large amounts regularly.
• Alcohol — While there's no direct chemical interaction, alcohol increases bleeding risk and can irritate the stomach lining. Moderate consumption is generally okay, but heavy drinking should be avoided.

What to Tell Your Doctor

Before starting Ticagrelor (and at every visit), make sure your doctor knows about:

• Every medication you take — prescription, over-the-counter, and herbal supplements
• Your aspirin dose — confirm you're taking 75–100 mg daily, not more
• Any new medications — even if prescribed by another doctor or dentist
• Upcoming surgeries or dental procedures — your doctor may need to temporarily stop Ticagrelor
• Any unusual bleeding or bruising — this could signal an interaction is causing problems

Keep an updated medication list in your wallet or phone. When you see any healthcare provider — doctor, dentist, pharmacist, or urgent care — show them the list so they can check for interactions before prescribing anything new.

Final Thoughts

Ticagrelor is an effective medication for preventing heart attacks and strokes, but it has several important drug interactions that require attention. The most critical things to remember: avoid strong CYP3A4 inhibitors and inducers, keep your aspirin dose at 75–100 mg daily, watch out for hidden NSAIDs, and skip the St. John's Wort.

For more about Ticagrelor, explore our guides on side effects, how it works, and uses and dosage. If you need to fill your prescription, search Medfinder to find Ticagrelor in stock near you.