prasugrel

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.

Availability ⬆ ⬇

(Generic available)

Tablets: 5 mg; 10 mg

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Acts by irreversibly binding its active metabolite to the P2Y₁₂ class of ADP receptors on platelets; inhibiting platelet activation and aggregation.

Therapeutic effects:

Decreased thrombotic events including cardiovascular death, nonfatal MI, and nonfatal stroke.

Classifications ⬆ ⬇

Therapeutic Classification: antiplatelet agents

Pharmacologic Classification: thienopyridines

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration (79%), then rapidly converted to an active metabolite.

Distribution: Unknown.

Protein Binding: Active metabolite: 98%.

Metabolism/Excretion: Active metabolite is metabolized to two inactive compounds; 68% excreted in the urine and 27% in feces as inactive metabolites.

Half-Life: Active metabolite: 7 hr (range 2–15 hr).

Time/Action Profile ⬆ ⬇

(effect on platelet function)

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

‡Following discontinuation.

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.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

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)

0713- Cosette Pharmaceuticals, Inc.
- 0713-0881- Effient
  - 0713-0881-30- 30 TABLET, COATED in 1 BOTTLE (0713-0881-30)

0713- Cosette Pharmaceuticals, Inc.
- 0713-0882- Effient
  - 0713-0882-30- 30 TABLET, COATED in 1 BOTTLE (0713-0882-30)

14501- MSN Laboratories Private Limited
- 14501-0072-
  - 14501-0072-2- 50 kg in 1 DRUM (14501-0072-2)

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)

29300- Unichem Pharmaceuticals (USA), Inc.
- 29300-301- Prasugrel
  - 29300-301-13- 30 TABLET, FILM COATED in 1 BOTTLE (29300-301-13)

29300- Unichem Pharmaceuticals (USA), Inc.
- 29300-302- Prasugrel
  - 29300-302-13- 30 TABLET, FILM COATED in 1 BOTTLE (29300-302-13)

43817- Panacea Biotec Limited
- 43817-239- PRASUGREL
  - 43817-239-01- 30 TABLET, FILM COATED in 1 BOTTLE (43817-239-01)

43817- Panacea Biotec Limited
- 43817-240- PRASUGREL
  - 43817-240-01- 30 TABLET, FILM COATED in 1 BOTTLE (43817-240-01)

51407- Golden State Medical Supply, Inc.
- 51407-444- Prasugrel
  - 51407-444-30- 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (51407-444-30)

51407- Golden State Medical Supply, Inc.
- 51407-445- Prasugrel
  - 51407-445-30- 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (51407-445-30)

53747- Unichem Laboratories Limited, India
- 53747-048-
  - 53747-048-00- 1 BAG in 1 DRUM (53747-048-00) / 3 kg in 1 BAG

55111- Dr.Reddy's Laboratories Limited
- 55111-928-
  - 55111-928-00- 1 kg in 1 DRUM (55111-928-00)

60240- Joyochem Co.,Ltd
- 60240-0275-
  60240-0275-1- 1 BAG in 1 DRUM (60240-0275-1) / 5 kg in 1 BAG (60240-0275-2)

60240- Joyochem Co.,Ltd
- 60240-0275-
  60240-0275-3- 1 BAG in 1 DRUM (60240-0275-3) / 10 kg in 1 BAG (60240-0275-4)

60240- Joyochem Co.,Ltd
- 60240-0275-
  60240-0275-5- 1 BAG in 1 DRUM (60240-0275-5) / 25 kg in 1 BAG (60240-0275-6)

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)

60505- Apotex Corp.
- 60505-4856- PRASUGREL
  - 60505-4856-3- 30 TABLET, FILM COATED in 1 BOTTLE (60505-4856-3)

60687- American Health Packaging
- 60687-883- Prasugrel
  - 60687-883-21- 30 BLISTER PACK in 1 CARTON (60687-883-21) / 1 TABLET, FILM COATED in 1 BLISTER PACK (60687-883-11)

63629- Bryant Ranch Prepack
- 63629-4829- Prasugrel
  - 63629-4829-1- 30 TABLET, FILM COATED in 1 BOTTLE (63629-4829-1)

63629- Bryant Ranch Prepack
- 63629-4829- Prasugrel
  - 63629-4829-2- 90 TABLET, FILM COATED in 1 BOTTLE (63629-4829-2)

65015- Mylan Laboratories Limited
- 65015-809-
  - 65015-809-61- 100 kg in 1 DRUM (65015-809-61)

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
- 65862-809-
  - 65862-809-37- 50 kg in 1 DRUM (65862-809-37)

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)

65977- Hetero Drugs Limited
- 65977-0076-
  - 65977-0076-1- 25 kg in 1 DRUM (65977-0076-1)

66003- Daiichi Sankyo Europe GmBH
- 66003-601-
  66003-601-01- 192000 TABLET, FILM COATED in 1 DRUM (66003-601-01)

66003- Daiichi Sankyo Europe GmBH
- 66003-602-
  66003-602-01- 96000 TABLET, FILM COATED in 1 DRUM (66003-602-01)

66039- Glenmark Life Sciences Limited
- 66039-887-
  66039-887-04- 50 kg in 1 DRUM (66039-887-04)

82245- Viyash Life Sciences Private Limited
- 82245-0102-
  82245-0102-1- 25 kg in 1 DRUM (82245-0102-1)

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Indications ⬇

Contraind./Precautions ⬆ ⬇