Prasugrel 💊
📖 About
Always check the BNF link here for the most up-to-date guidance.
Prasugrel is an oral P2Y12 receptor inhibitor used in combination with aspirin for dual antiplatelet therapy (DAPT), mainly in acute coronary syndromes (ACS) managed with PCI.
⚙️ Mode of Action
- 🩸 Irreversible P2Y12 ADP receptor antagonist → prevents platelet activation and aggregation.
- 🔬 Belongs to the thienopyridine drug class (like clopidogrel, ticlopidine).
- ⚡ Quicker onset of action and more consistent platelet inhibition than clopidogrel.
- Particularly effective in diabetic patients and those <75 years old.
💊 Indications / Dose
- 👉 Used with aspirin in ACS patients undergoing PCI (STEMI + PPCI, NSTEMI with PCI, stent thrombosis, or reinfarction on aspirin/clopidogrel).
- ACS + diabetes + PCI: Loading dose 60 mg PO, then 10 mg OD for 12 months.
- Elderly (>75), weight <60 kg, or high bleed risk: 5 mg OD.
📊 Dose Range (with Aspirin 75–81 mg OD)
| Name | Starting Dose | Frequency | Route |
|---|
| Prasugrel (initial) | 60 mg | Stat | PO |
| Prasugrel (maintenance) | 10 mg | OD × 1 year | PO |
| Prasugrel (maintenance if weight <60 kg, age >75, or bleed risk) | 5 mg | OD × 1 year | PO |
🔗 Interactions
- 📖 See BNF for complete list.
- 💊 Concomitant anticoagulants (warfarin, DOACs) → ↑ bleeding risk.
- Other antiplatelets (clopidogrel, ticagrelor) → avoid combination.
⚠️ Cautions
- 🚫 Avoid if high bleeding risk.
- Not indicated for stable coronary artery disease (only ACS).
- 📄 Discharge letter must specify dose + duration of therapy.
- 💉 Higher risk of major bleeding compared with clopidogrel.
⛔ Contraindications
- ❌ Prior stroke or TIA.
- ❌ Weight <60 kg (unless adjusted dose).
- ❌ Active pathological bleeding (e.g., GI bleed, intracranial haemorrhage).
😬 Side Effects
- 🩸 Bleeding (GI, intracranial, post-surgical).
- 🌸 Rash, hypersensitivity reactions.
- ⬇️ Thrombocytopenia, rare thrombotic thrombocytopenic purpura (TTP).
📚 References
- BNF – Prasugrel
- ESC & ACC/AHA guidelines on ACS and dual antiplatelet therapy.
