prasugrel hydrochloride: clinical use

Prescribing considerations

• Confirm that the indication involves acute coronary syndrome managed with percutaneous coronary intervention and concomitant aspirin.
• Balance ischaemic benefit against bleeding risk, particularly in older adults, people with lower body weight, recent trauma or surgery, recurrent gastrointestinal bleeding, peptic ulcer disease, renal impairment or moderate hepatic impairment.
• Coordinate peri-procedural decisions with cardiology where possible: interruption may increase thrombotic risk, while continuation increases procedural bleeding.
• Advise patients to report unusual bleeding and disclose treatment to healthcare professionals and dentists.

Contraindications and cautions

• Active pathological bleeding
• Previous stroke or transient ischaemic attack
• Severe hepatic impairment
• Hypersensitivity to prasugrel or a formulation excipient

Monitoring

• Assess clinically for bleeding, bruising and features of anaemia.
• Remain alert for hypersensitivity, including angioedema, especially after reactions to another thienopyridine.
• Investigate fever, thrombocytopenic-type bruising, neurological change, renal features or jaundice urgently for possible thrombotic thrombocytopenic purpura.
• Reassess bleeding risk when interacting medicines are introduced or an invasive procedure is planned.

Clinical pharmacology

Prasugrel is a prodrug rapidly converted to an active metabolite. Irreversible P2Y12 receptor binding suppresses ADP-mediated platelet activation; platelet function recovers as new platelets enter the circulation.

Formulation and product differences

• The selected Efient tablet is yellow and double-arrow shaped; the selected generic tablet is beige and oval.
• Both selected formulations are film-coated, contain lactose and should not be crushed or broken.
• Product-specific storage instructions differ, so follow the dispensing label and pack leaflet.

Tablet

Route: Oral

Strengths: 5 mg, 10 mg