Supplements and Ticagrelor.
Ticagrelor, sold under the brand names Brilique, Brilinta, is an antiplatelet agent: it reduces platelet aggregation.
Ticagrelor is an antiplatelet agent. UK prescribing is mostly for secondary cardiovascular prevention. Aspirin acetylates COX-1 in platelets for the platelet lifespan, which runs seven to ten days. Clopidogrel and the newer P2Y12 inhibitors block ADP receptors on platelets instead. The supplement surface is additive antiplatelet. Ginkgo biloba, garlic in concentrated extract form, fish oil at higher doses, curcumin, bromelain, andrographis, nattokinase, and vitamin E at higher doses all carry measurable platelet or fibrinolytic effects in human studies. None individually changes bleeding risk much at OTC doses. But the stack matters, and the supplement washout before surgery, usually about two weeks, applies. Any decision about the antiplatelet drug itself belongs with the prescriber, and stopping it unsupervised carries a serious risk of its own. CYP2C19 metabolism matters specifically for clopidogrel. Omeprazole and certain supplements at high doses can reduce its antiplatelet effect by blocking conversion to the active metabolite. The BNF flags this.
Below are the 8 documented pairs we have explicitly assessed against Ticagrelor in the Distil database: 8 amber. The pairs cluster around 2 mechanisms: Additive antiplatelet effect and CYP3A4 inhibition. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Last reviewed 14 September 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
Additive antiplatelet effect
Amber Does Bromelain interact with Ticagrelor?
Bromelain has mild blood-thinning activity that can add to ticagrelor's. Tell your GP if you take bromelain alongside ticagrelor, and stop high-dose bromelain about two weeks before any planned surgery.
Evidence: Limited human data, from small studies or case reports.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Fisetin interact with Ticagrelor?
Fisetin may mildly reduce platelet clumping, which could add a little to ticagrelor's blood-thinning effect. This is most relevant during a high-dose fisetin course. If you take ticagrelor and run a fisetin course, mention it to your GP and watch for bruising or bleeding.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Ginkgo Biloba interact with Ticagrelor?
Ginkgo and ticagrelor both act on platelets, the cells that start a clot, so taking them together may raise bleeding risk, and we would not start ginkgo alongside ticagrelor without your cardiology team agreeing. Never stop ticagrelor on your own, particularly in the first year after a stent, because stopping it carries a serious risk of its own: the ginkgo is the thing to stop, ideally at least two weeks before any planned surgery or dental work. Trials in people have not measured a change in clotting from ginkgo at the 120 to 240mg doses sold in the UK, so the caution rests on published reports of bleeding in ginkgo users and on the shared mechanism rather than on a measured effect alongside ticagrelor.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Omega-3 EPA interact with Ticagrelor?
Standard supplement doses of fish oil (under 1 gram of EPA+DHA per day) add only marginally to the antiplatelet effect of ticagrelor. At higher cardiology doses (3 grams per day and above), the combination more meaningfully increases bleeding risk. The combination is worth flagging before any planned surgery or dental procedure.
Evidence: Limited human data, from small studies or case reports.
Amber Does Pine Bark Extract interact with Ticagrelor?
Pine bark extract (pycnogenol) has a mild blood-thinning effect of its own, most clearly shown in smokers, that can add to ticagrelor's. The combined effect can mean more bruising or bleeding. Stop high-dose pine bark extract at least two weeks before any planned surgery and tell your GP if you take both together, especially if ticagrelor is combined with aspirin.
Evidence: Limited human data, from small studies or case reports.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Resveratrol interact with Ticagrelor?
Resveratrol can mildly reduce platelet clumping, which adds to ticagrelor's blood-thinning effect and may slightly raise bleeding risk. Concentrated supplements are the concern. If you take ticagrelor and use resveratrol, mention it to your GP and watch for bruising or bleeding.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin E interact with Ticagrelor?
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which may add to ticagrelor's blood-thinning effect. Lower doses have not been studied with ticagrelor, and with aspirin, another antiplatelet medicine, men taking 50mg of vitamin E a day had more bleeding from the gums than men taking neither, so a low dose cannot be assumed to add nothing. Tell whoever prescribes your ticagrelor before taking vitamin E at any dose, and stop vitamin E at least two weeks before any planned surgery.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
CYP3A4 inhibition
Amber Does Andrographis interact with Ticagrelor?
Andrographis may raise ticagrelor levels by slowing the gut enzymes and pumps that clear it, and it also has a mild blood-thinning action of its own, so both routes point the same way: more bleeding risk. Grapefruit juice, which slows the same gut enzyme, more than doubled ticagrelor levels in healthy volunteers, which is why this route is taken seriously even though studies of andrographis with ticagrelor have not been done. If you take ticagrelor, tell your doctor or pharmacist before starting andrographis and watch for unusual bruising, nosebleeds, or blood in your urine or stool.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
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How we grade severity, choose what's in scope, and what we exclude.
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