Prasugrel Brand Name– Effient
What is Prasugrel
Prasugrel is a thienopyridine platelet aggregation inhibitor similar to ticlopidine and clopidogrel.
Prasugrel is indicated for the reduction of thrombotic cardiovascular events (including stent thrombosis) in patients with acute coronary syndrome (unstable angina, non-ST-elevation myocardial infarction [NSTEMI], ST-elevation myocardial infarction [STEMI]) being managed with percutaneous coronary intervention (PCI).
The approval of prasugrel was based on results from the TRITON-TIMI 38 clinical trial, which compared prasugrel with clopidogrel in reducing cardiovascular events in 13,608 patients with acute coronary syndrome (ACS) managed with PCI. Results from the study showed that patients receiving prasugrel had a greater reduction in the combined endpoint of cardiovascular death, non-fatal heart attack or non-fatal stroke compared to clopidogrel, with the difference being predominantly due to a reduction in myocardial infarction, with no difference in stroke and little difference on cardiovascular death.
The benefit of prasugrel compared to clopidogrel was seen as early as 3 days and continued throughout the follow-up period (up to 15 months, average duration of therapy 14.5 months).
In addition, there were fewer cases of stent thrombosis in patients treated with prasugrel compared with clopidogrel. Although the benefit of reduction in thrombotic events was greater with prasugrel compared to clopidogrel, bleeding was seen more frequently in patients receiving prasugrel.
Prasugrel (Effient) was approved by the FDA in July 2009.
Indications
- acute myocardial infarction
- arterial thromboembolism prophylaxis
- percutaneous coronary intervention (PCI)
- unstable angina
For arterial thromboembolism prophylaxis (thrombotic cardiovascular events including stent thrombosis) in patients with acute coronary syndrome (i.e., unstable angina, non-ST-elevation myocardial infarction [NSTEMI], or ST-elevation acute myocardial infarction [STEMI]) who are to be managed with percutaneous coronary intervention (PCI)
Side Effects
- anaphylactoid reactions
- anemia
- angioedema
- atrial fibrillation
- back pain
- bleeding
- bradycardia
- chest pain (unspecified)
- cough
- diarrhea
- dizziness
- dyspnea
- epistaxis
- fatigue
- fever
- GI bleeding
- headache
- hematoma
- hemoptysis
- hypercholesterolemia
- hyperlipidemia
- hypertension
- hypotension
- intracranial bleeding
- leukopenia
- nausea
- neutropenia
- new primary malignancy
- peripheral edema
- rash
- retroperitoneal bleeding
- thrombocytopenia
Monitoring Parameters
- CBC
Contraindications
- abrupt discontinuation
- anticoagulant therapy
- Asian patients
- bleeding
- body weight less than 60 kg
- breast-feeding
- children
- coronary artery bypass graft surgery (CABG)
- geriatric
- GI bleeding
- hepatic disease
- intracranial bleeding
- peptic ulcer disease
- pregnancy
- renal impairment
- stroke
- surgery
- thienopyridine hypersensitivity
- thrombotic thrombocytopenic purpura (TTP)
- trauma
Interactions
- Abciximab
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Codeine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Propoxyphene
- Acetaminophen; Tramadol
- Ado-Trastuzumab emtansine
- Alfentanil
- Altretamine
- Aminolevulinic Acid
- Anagrelide
- Antimetabolites
- Antithrombin III
- Antithymocyte Globulin
- Apixaban
- Argatroban
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Belladonna; Opium
- Benzhydrocodone; Acetaminophen
- Betrixaban
- Bexarotene
- Bivalirudin
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Cangrelor
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Chlorambucil
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Cilostazol
- Cladribine
- Clofarabine
- Clopidogrel
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Collagenase
- Dabigatran
- Dalteparin
- Danaparoid
- Danazol
- Dasatinib
- Defibrotide
- Denileukin Diftitox
- Desirudin
- Desvenlafaxine
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Dipyridamole
- Drotrecogin Alfa
- Duloxetine
- Edoxaban
- Elexacaftor; tezacaftor; ivacaftor
- Enoxaparin
- Eptifibatide
- Estramustine
- Fentanyl
- Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
- Fludarabine
- Folate analogs
- Fondaparinux
- Garlic, Allium sativum
- Ginger, Zingiber officinale
- Ginkgo, Ginkgo biloba
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Heparin
- Homatropine; Hydrocodone
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Ibritumomab Tiuxetan
- Ibrutinib
- Ibuprofen; Oxycodone
- Icosapent ethyl
- Idelalisib
- Iloprost
- Inotersen
- Intravenous Lipid Emulsions
- Isavuconazonium
- Ivacaftor
- Lepirudin
- Levomilnacipran
- Levorphanol
- Lomustine, CCNU
- Lumacaftor; Ivacaftor
- Meperidine
- Meperidine; Promethazine
- Mercaptopurine, 6-MP
- Methadone
- Methoxsalen
- Methylsulfonylmethane, MSM
- Milnacipran
- Morphine
- Morphine; Naltrexone
- Mycophenolate
- Nelarabine
- Nonsteroidal antiinflammatory drugs
- Obinutuzumab
- Opiate Agonists
- Oxycodone
- Oxymorphone
- Pegaspargase
- Pentosan
- Pentostatin
- Pentoxifylline
- Phentermine; Topiramate
- Photosensitizing agents (topical)
- Platelet Glycoprotein IIb/IIIa Inhibitors
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
- Propoxyphene
- Purine analogs
- Remifentanil
- Rivaroxaban
- Selective serotonin reuptake inhibitors
- Selumetinib
- Sodium Hyaluronate, Hyaluronic Acid
- Sufentanil
- Sulfinpyrazone
- Tapentadol
- Tezacaftor; Ivacaftor
- Thioguanine, 6-TG
- Thrombolytic Agents
- Tinzaparin
- Tirofiban
- Topiramate
- Tramadol
- Trazodone
- Treprostinil
- Tretinoin, ATRA
- Venlafaxine
- Verteporfin
- Vilazodone
- Vorapaxar
- Vorinostat
- Vortioxetine
- Warfarin
