Ticagrelor vs Prasugrel: What You Need to Know

If you or a loved one has been prescribed an antiplatelet drug, you’ve probably heard the names ticagrelor and prasugrel. Both are powerful medicines that stop platelets from sticking together, but they aren’t interchangeable. Knowing the main differences can help you stick to the right plan and avoid surprises.

How They Work and When They’re Used

Ticagrelor (brand name Brilinta) and prasugrel (Effient) belong to the same drug family, but ticagrelor binds reversibly to the P2Y12 receptor, while prasugrel binds irreversibly. Because of this, ticagrelor’s effect wears off faster once you stop taking it, which can be handy if surgery is coming up. Both drugs are typically added to aspirin after a heart attack, after a stent is placed, or when you’ve had an ischemic stroke.

Dosage, Speed, and How “Strong” They Are

Ticagrelor is taken twice a day (90 mg each dose) and can be started right after the acute event. Prasugrel is a once‑daily pill (10 mg) but requires a loading dose of 60 mg and should only be used in patients who can tolerate a higher bleeding risk. In head‑to‑head trials, prasugrel showed a slightly larger drop in heart‑related events, but it also brought more major bleeding, especially in older patients or those weighing under 60 kg.

When you compare the two, look at three practical points:

• Bleeding risk: Prasugrel = higher; ticagrelor = moderate.
• Kidney or liver disease: Ticagrelor needs dose adjustment; prasugrel is usually avoided.
• Adherence: Twice‑daily dosing can be a hassle, so some patients prefer prasugrel’s once‑daily schedule.

Side‑effects also differ. Ticagrelor often causes shortness of breath and a bitter taste in the mouth. Prasugrel’s main complaint is bruising or bleeding that’s harder to stop because it binds permanently to platelets.

Who should avoid each drug? Patients with a history of intracranial bleeding, severe asthma, or active bleeding should steer clear of ticagrelor. Prasugrel isn’t recommended for anyone over 75, under 60 kg, or with a prior stroke or TIA.

Cost can matter too. In many places, ticagrelor is priced higher than generic clopidogrel, while prasugrel sits somewhere in between. Insurance coverage varies, so checking your plan before starting can save a trip to the pharmacy.

Bottom line: If you’re low‑risk for bleeding and need a fast‑acting, reversible drug, ticagrelor is often the pick. If you’re comfortable with a higher bleed chance and want a once‑daily pill, prasugrel may be better—provided you fit the age and weight criteria.

Always talk with your cardiologist about your personal risk factors. They’ll weigh the study data, your health history, and lifestyle to choose the right antiplatelet for you.