Brilinta vs Plavix: what's the difference?
Which is better or more effective Brilinta or Plavix?
Effectiveness of Brilinta vs Plavix
Brilinta (ticagrelor) and Plavix (clopidogrel) are used to prevent blood clots in patients with heart issues to reduce risk of having a stroke, serious heart problems, or death.
Using PLATO clinical trial figures Brilinta appeared to work better than clopidogrel as Brilinta had 1.9% less deaths in the first year of treatment from CV issues , MI or stroke.
The PLATO clinical trial studied Brilinta + aspirin compared to clopidogrel + aspirin, was sponsored by AstraZeneca who makes Brilinta. The percentage of patients that had cardiovascular (CV) death, myocardial infarction (MI) or stroke in the first year of treatment was:
- Ticagrelor + aspirin = 9.8%
- Cloidogrel + aspirin =11.7%
- The difference between two groups is 11.7% - 9.8% =1.9 %
- Ticagrelor had 1.9% less deaths from CV, MI and stroke compared to clopidogrel.
The CURE clinical trial studied Plavix + aspirin compared to placebo + aspirin. The percentage of CV death, MI or stroke in the first year of treatment was
- Plavix + aspirin = 9.3%
- placebo + aspirin = 11.4%
In the CURE study Plavix + aspirin had a lower rate of CV death, MI or stroke in the first year of treatment.
Boxed warnings of Brilinta vs Plavix
Both have boxed warnings, but for different issues.
Plavix boxed warning is for
- "CYP2C19 poor metabolizers" as their bodies are unable to convert Plavix into the active form, so that it has a limited effect in these people.
Brilinta has two boxed warnings
- bleeding risk
- doses of aspirin above 100 mg daily reduce effectiveness of Brilinta therefore should be avoided.
Side Effects of Brilinta vs Plavix
Like all medications they both have side effects, the most commonly discussed side effect is bleeding for both medicines, due to their effects on reducing blood clotting. There are a number of different studies measuring the bleeding side effect, but the different studies have different severity of bleeding categories and different ways of measuring this side effect. This makes it hard to compare which one has more bleeding side effects.
Brilinta patients have a higher level of breathing difficulties (dyspnea) when compared to Plavix.
For more information on other side effects click on
Dosing of Brilinta vs Plavix
Plavix is a once a day tablet compared to Brilinta which is a twice a day tablet.
Table comparing Brilinta and Plavix
| Brilinta (ticagrelor) | Plavix (clopidogrel) | |
| Indication |
Acute coronary |
Acute coronary syndrome. Recent MI, recent stroke, or established peripheral arterial disease. |
| Boxed warning |
Yes: Bleeding risk, reduced effect with aspirin dose above 100mg day |
Yes: Reduced effect on patients who are "CYP2C19 poor metabolizers" |
| FDA approval date | 20 July 2011 | 17 November 1997 |
| Generic availability | No | Yes |
| Action | Reversibly interact with the platelet P2Y12 ADP-receptor | Irreversible binding to the P2Y12 class of ADP receptors on platelets. |
| Form |
60mg oral tablet 90mg oral tablet |
75mg oral tablet 300mg oral tablet |
| Frequency | Twice daily | Once daily |
| Dosage |
Acute coronary syndrome or a history of myocardial infarction: 180mg loading dose then 90mg twice daily for one year, then reduce to 60mg twice daily Reduce the risk of stroke in patients with an acute ischemic stroke or high-risk transient ischemic attack: 180mg loading dose then 90mg twice a day for up to 30 days |
Acute Coronary Syndrome: loading dose 300mg then 75mg once daily Recent MI, Recent Stroke, or Established Peripheral Arterial Disease: 75mg daily - no loading dose required |
| Antidote | No | No |
| Most commonly reported side effects | Bleeding 11.6 %, breathing difficulties 15-21% | Bleeding 11.2% |
| Interactions | Simvastatin, lovastatin, digoxin, opioids, aspirin, strong CYP3A inducers, strong CYP3A Inhibitors | CYP2C19 inhibitors, omeprazole or esomeprazole, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin (CYP2C9 Substrates), SSRIs and SNRIs, repaglinide (CYP2C8 substrates) |
| Effectiveness: (Number of patients who had a cardiovascular death, MI or stroke in first year) | Ticagrelor + aspirin = 9.8% (PLATO study) |
Plavix +aspirin = 9.3% (CURE study) |
Bottom Line:
- Brilinta (ticagrelor) appears to be slightly more effective than Plavix (clopidogrel) in reducing the percentage of CV death, MI or stroke in the first year of treatment
- Brilinta patients had more breathing difficulties as a side effect compared to Plavix patients.
- Brilinta has a blackbox warning for severity of bleeding risk and also for reduced effect with aspirin dose above 100mg day.
- Plavix has a black box warning for patients who are "CYP2C19 poor metabolizers” as Plavix will have reduced effect on these patients.
Related Questions
References
- Medication information for Plavix: https://www.drugs.com/pro/plavix.html
- Medication information for Brilinta: https://www.drugs.com/pro/brilinta-tablets.html
- Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes: https://www.nejm.org/doi/full/10.1056/NEJMoa0904327
- Compared efficacy of clopidogrel and ticagrelor in treating acute coronary syndrome: a meta-analysis:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267904/?report=reader
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