prasugrel: clinical use

Prescribing considerations

• Confirm the licensed context of acute coronary syndrome managed with PCI and concomitant aspirin.
• Assess bleeding risk carefully, particularly with older age, low body weight, recent trauma or surgery, recurrent gastrointestinal bleeding, renal impairment or moderate hepatic impairment.
• Review all anticoagulants, antiplatelets, NSAIDs and planned invasive or dental procedures.
• Avoid unplanned interruption because premature antiplatelet withdrawal after PCI may increase thrombosis and myocardial infarction risk.
• Consider possible delayed antiplatelet action when morphine or another opioid is co-administered.

Contraindications and cautions

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

Monitoring

• Monitor clinically for overt or occult bleeding and symptoms of anaemia.
• Investigate unexplained bruising, haemoglobin reduction or thrombocytopenia.
• Remain alert for hypersensitivity and thrombotic thrombocytopenic purpura.
• Reassess bleeding risk when renal or hepatic function, concomitant treatment or procedural plans change.

Clinical pharmacology

Prasugrel is rapidly converted to an active thiol metabolite that irreversibly inhibits platelet P2Y12 ADP receptors. The active metabolite is highly protein-bound and is subsequently converted to inactive metabolites.

Formulation and product differences

• The selected product contains lactose and is essentially sodium-free.
• The tablet must not be crushed or broken.
• Some packs contain a non-edible silica tablet that must remain in the blister.

Tablet

Route: Oral

Strengths: 5 mg, 10 mg