Ticagrelor and Buprenorphine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Buprenorphine
Ticagrelor
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Here's what's going on. Buprenorphine is an opioid, and opioids slow down how fast your stomach empties into your intestines. Ticagrelor (Brilinta) is a blood thinner you swallow that keeps platelets from clumping and helps prevent clots. When your stomach empties more slowly, ticagrelor gets absorbed slower and in a smaller amount, so it may not work as strongly or as quickly as it should.
This matters most right after a heart event, when doctors need the ticagrelor to kick in fast. The good news is your care team knows about this and can plan around it. Please keep taking both exactly as prescribed and let your pharmacist or doctor know you take both.
Effect: Reduced and delayed absorption of oral ticagrelor when coadministered with opioid agonists such as buprenorphine.
Mechanism: Opioid-induced slowing of gastric emptying reduces ticagrelor absorption. Ticagrelor is active itself and also forms an active metabolite; both parent and metabolite exposure fall.
- Magnitude (opioid class data): IV morphine reduced ticagrelor AUC by up to 25% in healthy adults and up to 36% in ACS/PCI patients; Tmax delayed 1 to 2 hours. IV fentanyl showed similar effects on exposure and platelet inhibition.
- Evidence: Probable. Severity: Major. Onset: Acute.
- Management: In ACS patients needing an opioid, consider a parenteral antiplatelet agent. Monitor platelet inhibition/clinical response.
What happens
Reduced absorption of ticagrelor
Interaction Deep Dive
When ticagrelor is given together with opioid agonists, the absorption of clopidogrel is both slowed and diminished, an effect thought to stem from delayed gastric emptying, which lowers exposure to clopidogrel metabolites. One clinical study found that giving 5 mg of intravenous morphine alongside a 180 mg loading dose of ticagrelor lowered the observed mean ticagrelor exposure by as much as 25% in healthy adults and by as much as 36% in ACS patients undergoing PCI, with Tmax pushed back by 1 to 2 hours. Exposure to the active metabolite fell by a comparable degree. Administering intravenous fentaNYL together with a 180 mg loading dose of ticagrelor in ACS patients undergoing PCI produced comparable effects on both ticagrelor exposure and platelet inhibition. In acute coronary syndrome patients who need concurrent morphine or another opioid agonist, consider using a parenteral antiplatelet agent1.
Why it happens (mechanism)
Slowed gastric emptying
How to manage this interaction
What your care team may do:
- In an acute heart situation where fast platelet blockade is needed, your team may choose an injectable (IV) antiplatelet medicine instead of relying only on swallowed ticagrelor, since the opioid can slow and lower how much ticagrelor is absorbed.
- They may watch your response more closely around the time both are given.
What you can do:
- Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Tell your pharmacist and doctor that you take buprenorphine, especially if you are being treated for a heart problem.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In a clinical trial, giving 5 mg of intravenous morphine together with a 180 mg loading dose of ticagrelor reduced the observed mean ticagrelor exposure by as much as 25% in healthy adults and by as much as 36% in ACS patients undergoing PCI. Tmax was delayed by 1 to 2 hours. Exposure of the active metabolite fell by a comparable amount 1.
b) In a clinical trial, administering intravenous fentaNYL along with a 180 mg loading dose of ticagrelor in ACS patients undergoing PCI led to a reduction in the observed mean ticagrelor exposure, and Tmax was delayed 1.
Common questions
Can I take Ticagrelor and Buprenorphine together?
Buprenorphine can slow your stomach and reduce how much ticagrelor your body absorbs, so ticagrelor may work less well, especially in an acute heart setting. Keep taking both as prescribed and make sure your care team knows you use both so they can adjust or monitor as needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ticagrelor and Buprenorphine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Ticagrelor and Buprenorphine interaction managed?
What your care team may do: In an acute heart situation where fast platelet blockade is needed, your team may choose an injectable (IV) antiplatelet medicine instead of relying only on swallowed ticagrelor, since the opioid can slow and lower how much ticagrelor is absorbed. They may watch your response more closely around the time both are given. What you can do: Keep taking both medicines exactl… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Ticagrelor or Buprenorphine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: BRILINTA(R) oral tablets, ticagrelor oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2024. DailyMed
Keep reading about Buprenorphine
Keep reading about Ticagrelor
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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