Indications
Prasugrel is indicated to reduce the rate of thrombotic cardiovascular (CV) events (including stent thrombosis) in patients with acute coronary syndrome (ACS) who are to be managed with percutaneous coronary intervention (PCI) as follows:
- Patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI).
- Patients with ST-elevation myocardial infarction (STEMI) when managed with primary or delayed PCI.
Therapeutic Class
Anti-platelet drugs
Pharmacology
Prasugrel is a thienopyridine derivative which is formulated as a hydrochloride salt. Prasugrel is an inhibitor of platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y 12 class of ADP receptors on platelets. Since platelets participate in the initiation and/or evolution of thrombotic complications of atherosclerotic disease, inhibition of platelet function can result in the reduction of the rate of cardiovascular events such as death, myocardial infarction or stroke.
Dosage & Administration
Prasugrel should be initiated with a single 60 mg loading dose and then continued at 10 mg once a day. Patients taking Prasugrel should also take aspirin (75 mg to 325 mg) daily. Prasugrel may be administered with or without food.In patients with acute coronary syndrome (ACS) who are managed with PCI, premature discontinuation of any antiplatelet agent, including Prasugrel, could result in an increased risk of thrombosis, myocardial infarction or death due to the patient’s underlying disease. A treatment of up to 12 months is recommended, unless the discontinuation of Prasugrel is clinically indicated.
In case of patients weighing ≤ 60 kg or patient’s ≥ 75 years old, Prasugrel should be given as a single 60 mg loading dose and then continued at a 5 mg once-daily dose.
Interaction
Coadministration of prasugrel and warfarin increases the risk of bleeding. Coadministration of Prasugrel and NSAIDs (used chronically) may increase the risk of bleeding. Prasugrel can be administered with drugs that are inducers or inhibitors of cytochrome P450 enzymes. Prasugrel can be administered with aspirin (75 mg to 325 mg/day), heparin, GPIIb/IIIa inhibitors, statins, digoxin, and drugs that elevate gastric pH, including proton pump inhibitors and H2 blockers.
Contraindications
Prasugrel should be avoided in case of hypersensitivity to the active substance or to any of the excipients, active pathological bleeding, and history of stroke or transient ischaemic attack (TIA), severe hepatic impairment.
Side Effects
Bleeding (non-CABG related & CABG related) and Thrombotic thrombocytopenic purpura. Besides this hypertension, headache, back pain, dizziness, cough, bradycardia, rash & peripheral edema etc. may happen.
Pregnancy & Lactation
Pregnancy Category B. There are no adequate and well-controlled studies of Prasugrel use in pregnant women. Prasugrel should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.It is not known whether Prasugrel is excreted in human milk. Because many drugs are excreted in human milk, prasugrel should be used during nursing only if the potential benefit to the mother justifies the potential risk to the nursing infant.
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