Supplements and Ticagrelor.
Ticagrelor, sold under the brand name Brilique, 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, and vitamin E at higher doses all carry measurable platelet effects in human studies. None individually changes bleeding risk much at OTC doses. But the stack matters, and the six week washout window before surgery applies. 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 6 documented pairs we have explicitly assessed against Ticagrelor in the Distil database: 6 amber. The pairs cluster around 1 mechanism: Additive antiplatelet effect. 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
Additive antiplatelet effect
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.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
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.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
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.
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 a week before any planned surgery and tell your GP if you take both together, especially if ticagrelor is combined with aspirin.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
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.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
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. At low supplement doses (100 to 200 IU) the effect is minimal. Keep vitamin E to modest mixed-tocopherol doses, tell your GP if you take high-dose vitamin E, and stop it six weeks before any planned surgery.
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.
How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
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This page checks the pairs you enter. The personalised Distil report goes further:
- the same graded, cited interaction check across your whole stack, not just the pairs you thought to type in
- where your current routine may be leaving you short of your goals
- the evidence-backed compounds worth adding, and the ones worth dropping
It's a paid report: £79, or £49 for the first 25 customers. The interactions check is one section of it, and you can read a real one in full before you buy.
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If a supplement or medication you take isn't in our autocomplete, tell us. We go through what people flag every week and add what's missing.