OralAcute coronary syndromeAdult: 60 mg as loading dose, followed by 10 mg once daily for up to 12 mth, given in combination w/ aspirin. Elderly: ≥75 yr Maintenance: 5 mg once daily.
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Patient w/ low body wt (<60 kg): 5 mg once daily as maintenance dose.
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Severe (Child-Pugh class C): Contraindicated.
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May be taken with or without food.
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Active pathological bleeding, history of stroke or transient ischaemic attack. Severe hepatic impairment (Child-Pugh class C).
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Patient w/ propensity to bleed, low body wt (<60 kg). Patient who will undergo CABG and other surgical procedure; coronary angiography in UA/NSTEMI patients. Elderly (≥75 yr). Pregnancy and lactation.
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Angioedema, anaphylaxis, HTN, hyperlipidaemia, headache, back pain, dyspnoea, nausea, dizziness, cough, hypotension, fatigue, non-cardiac chest pain, AF, bradycardia, leucopenia, rash, pyrexia, peripheral oedema, extremity pain, diarrhoea.
Potentially Fatal: Serious bleeding, thrombotic thrombocytopenic purpura.
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Monitor Hb and haematocrit periodically; may consider platelet function testing.
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Symptoms: Prolonged bleeding time and subsequent bleeding complications. Management: Platelet transfusion and/or other blood products may be considered.
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Increased risk of bleeding w/ oral anticoagulants (e.g. warfain), clopidogrel, NSAIDs and fibrinolytics.
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Description: Prasugrel is a prodrug that inhibits platelet activation and aggregation. The active metabolite irreversibly blocks the P2Y12 component of adenosine diphosphate (ADP) receptors on the platelet, which prevents activation of the GPIIb/IIIa receptor complex, thereby reducing platelet activation and aggregation. Onset: Inhibition of platelet aggregation: <30 min (dose-dependent). Pharmacokinetics: Absorption: Rapidly absorbed from the GI tract. Time to peak plasma concentration: Approx 30 min. Distribution: Plasma protein binding: Approx 98%. Metabolism: Undergoes hydrolysis in the intestines before being metabolised by CYP450 isoenzymes to the active metabolite (R-138727) which is further metabolised to 2 inactive compounds. Excretion: Via urine (approx 68%) and faeces (approx 27%). Elimination half-life: Approx 7.4 hr.
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Anon. Prasugrel. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/08/2014. Buckingham R (ed). Prasugrel Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/08/2014. Effient (prasugrel hydrochloride) 5 mg and 10 mg Tablets. U.S. FDA. https://www.fda.gov/. Accessed 06/08/2014. McEvoy GK, Snow EK, Miller J et al (eds). Prasugrel Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 06/08/2014.
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