prasugrel

ROUTE	ONSET	PEAK	DURATION
PO	within 1 hr	2 hr	5–9 days‡

Contraindicated in:

Hypersensitivity;
Active pathological bleeding;
History of transient ischemic attack or stroke.

Use Cautiously in:

Patients about to undergo coronary artery bypass grafting (CABG) (↑ risk of bleeding; discontinue at least 7 days prior to surgery);
Premature discontinuation (↑ risk of stent thrombosis, MI, and death);
Body weight <60 kg, propensity to bleed, severe hepatic impairment, concurrent use of medications that ↑ the risk of bleeding (↑ risk of bleeding);
Hypotension in the setting of recent coronary angiography, PCI, CABG, or other surgical procedure (suspect bleeding but do not discontinue prasugrel);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established in children;
Geri: Appears on Beers list. risk of major bleeding compared to clopidogrel, especially in patients 75 yrs old. Use with caution in older adults, especially in patients 75 yrs old. If used in patients 75 yrs old, consider using a lower dose (5 mg once daily).

Adv. Reactions/Side Effects ⬆ ⬇

CV: atrial fibrillation, bradycardia, hypertension, hypotension, peripheral edema

Derm: rash

GI: diarrhea, nausea

Hemat: BLEEDING, leukopenia, THROMBOTIC THROMBOCYTOPENIC PURPURA

Metab: hyperlipidemia

MS: back pain, extremity pain, non-cardiac chest pain

Neuro: dizziness, fatigue, headache

Resp: cough, dyspnea

Misc: fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA)

Interactions ⬆ ⬇

Drug-drug:

↑risk of bleeding with warfarin and NSAIDs.
Opioids may ↓ absorption of active metabolite and ↓ antiplatelet effects; consider using parenteral antiplatelet in patients with acute coronary syndrome if concurrent use of opioids needed.

Route/Dosage ⬆ ⬇

Aspirin 75–325 mg/daily should be taken concurrently
PO (Adults ≥60 kg): 60 mg initially as a loading dose, then 10 mg once daily.
PO (Adults <60 kg): 60 mg initially as a loading dose, then consider maintenance dose of 5 mg once daily.

Availability ⬆ ⬇

(Generic available)

Tablets: 5 mg; 10 mg

Assessment ⬆ ⬇

Assess patient for symptoms of stroke, peripheral vascular disease, or MI periodically during therapy.
Monitor patient for signs of thrombotic thrombocytopenic purpura (thrombocytopenia, microangiopathic hemolytic anemia, neurologic findings, renal dysfunction, fever). May rarely occur, even after short exposure (<2 wk). Requires prompt treatment.

Lab Test Considerations:

Monitor bleeding time during therapy. Prolonged bleeding time, which is time- and dose-dependent, is expected.
- Monitor CBC with differential and platelet count periodically during therapy. Thrombocytopenia and anemia may rarely occur.

Implementation ⬆ ⬇

Discontinue prasugrel 7 days before planned surgical procedures.
- Patients should take aspirin 75–325 mg daily with prasugrel.
- In patients with UA or NSTEMI, dose is usually administered at time of diagnosis or at time of PCI.
- In patients with STEMI presenting within 12 hrs of symptom onset, loading dose is usually administered at time of diagnosis or at time of PCI.
PO: Administer once daily without regard to food. DNC: Swallow tablets whole; do not break.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. Take missed doses as soon as possible unless almost time for next dose; do not double doses. Do not discontinue without consulting health care professional. Advise patient to read Medication Guide before taking and with each Rx refill; in case of changes. Instruct patient to keep prasugrel in original container with dessicant, and keep tightly capped to protect from moisture.
Inform patient that they will bleed and bruise more easily and will take longer to stop bleeding. Notify health care professional immediately if you have unexpected bleeding or bleeding that lasts a long time, bleeding that is severe or you cannot control, pink or brown urine, red or black stool (looks like tar), bruises that happen without a known cause or get larger, cough up blood or blood clots, vomit blood or your vomit looks like "coffee grounds."
Advise patient to notify health care professional promptly if fever, weakness, skin paleness, purple skin patches, yellowing of skin or eyes, chills, sore throat, neurological changes, or unusual bleeding or bruising, swelling of lips, difficulty breathing, rash, or hives occur.
Advise patient to notify health care professional and dentists of medication regimen prior to treatment or surgery.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially NSAIDs.
Rep: Advise female patient to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.

Evaluation/Desired Outcomes ⬆ ⬇

Prevention of stroke, MI, and vascular death in patients at risk.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

0002- Eli Lilly and Company
- 0002-5121- Effient
  - 0002-5121-30- 30 TABLET, FILM COATED in 1 BOTTLE (0002-5121-30)

0002- Eli Lilly and Company
- 0002-5121- Effient
  - 0002-5121-52- 24 BLISTER PACK in 1 CARTON (0002-5121-52) > 1 TABLET, FILM COATED in 1 BLISTER PACK (0002-5121-01)

0002- Eli Lilly and Company
- 0002-5123- Effient
  - 0002-5123-30- 30 TABLET, FILM COATED in 1 BOTTLE (0002-5123-30)

0002- Eli Lilly and Company
- 0002-5123- Effient
  - 0002-5123-77- 90 BLISTER PACK in 1 CARTON (0002-5123-77) > 1 TABLET, FILM COATED in 1 BLISTER PACK (0002-5123-01)

0378- Mylan Pharmaceuticals Inc.
- 0378-5185- Prasugrel
  - 0378-5185-93- 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-5185-93)

0378- Mylan Pharmaceuticals Inc.
- 0378-5186- Prasugrel
  - 0378-5186-93- 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (0378-5186-93)

0440- Liberty Pharmaceuticals, Inc.
- 0440-0604- PRASUGREL
  - 0440-0604-30- 30 TABLET, FILM COATED in 1 BOTTLE (0440-0604-30)

0440- Liberty Pharmaceuticals, Inc.
- 0440-0605- PRASUGREL
  - 0440-0605-30- 30 TABLET, FILM COATED in 1 BOTTLE (0440-0605-30)

16729- Accord Healthcare Inc.
- 16729-272- Prasugrel
  - 16729-272-10- 30 TABLET, FILM COATED in 1 BOTTLE (16729-272-10)

16729- Accord Healthcare Inc.
- 16729-273- Prasugrel
  - 16729-273-10- 30 TABLET, FILM COATED in 1 BOTTLE (16729-273-10)

43817- Panacea Biotec Ltd.
- 43817-239- Prasugrel
  - 43817-239-01- 30 TABLET, FILM COATED in 1 BOTTLE (43817-239-01)

43817- Panacea Biotec Ltd.
- 43817-240- Prasugrel
  - 43817-240-01- 30 TABLET, FILM COATED in 1 BOTTLE (43817-240-01)

48792- Sunshine Lake Pharma Co., Ltd.
- 48792-7821- prasugrel
  - 48792-7821-1- 30 TABLET, FILM COATED in 1 BOTTLE (48792-7821-1)

48792- Sunshine Lake Pharma Co., Ltd.
- 48792-7822- prasugrel
  - 48792-7822-1- 30 TABLET, FILM COATED in 1 BOTTLE (48792-7822-1)

50090- A-S Medication Solutions
- 50090-4118- Prasugrel
  - 50090-4118-0- 30 TABLET, FILM COATED in 1 BOTTLE (50090-4118-0)

60505- Apotex Corp.
- 60505-4642- Prasugrel
  - 60505-4642-3- 30 TABLET, FILM COATED in 1 BOTTLE (60505-4642-3)

60505- Apotex Corp.
- 60505-4643- Prasugrel
  - 60505-4643-3- 30 TABLET, FILM COATED in 1 BOTTLE (60505-4643-3)

60687- American Health Packaging
- 60687-412- Prasugrel
  - 60687-412-21- 30 BLISTER PACK in 1 BOX, UNIT-DOSE (60687-412-21) > 1 TABLET, FILM COATED in 1 BLISTER PACK (60687-412-11)

65162- Amneal Pharmaceuticals LLC
- 65162-001- Prasugrel
  - 65162-001-03- 30 TABLET, FILM COATED in 1 BOTTLE (65162-001-03)

65162- Amneal Pharmaceuticals LLC
- 65162-002- Prasugrel
  - 65162-002-03- 30 TABLET, FILM COATED in 1 BOTTLE (65162-002-03)

65862- Aurobindo Pharma Limited
- 65862-829- Prasugrel
  - 65862-829-03- 3 BLISTER PACK in 1 CARTON (65862-829-03) > 10 TABLET, FILM COATED in 1 BLISTER PACK (65862-829-10)

65862- Aurobindo Pharma Limited
- 65862-829- Prasugrel
  - 65862-829-30- 30 TABLET, FILM COATED in 1 BOTTLE (65862-829-30)

65862- Aurobindo Pharma Limited
- 65862-830- Prasugrel
  - 65862-830-03- 3 BLISTER PACK in 1 CARTON (65862-830-03) > 10 TABLET, FILM COATED in 1 BLISTER PACK (65862-830-10)

65862- Aurobindo Pharma Limited
- 65862-830- Prasugrel
  - 65862-830-30- 30 TABLET, FILM COATED in 1 BOTTLE (65862-830-30)

67877- Ascend Laboratories, LLC
- 67877-604- PRASUGREL
  - 67877-604-30- 30 TABLET, FILM COATED in 1 BOTTLE (67877-604-30)

67877- Ascend Laboratories, LLC
- 67877-605- PRASUGREL
  - 67877-605-30- 30 TABLET, FILM COATED in 1 BOTTLE (67877-605-30)

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇