Formulary
Prasugrel: Indications, Dosing, Side Effects and Interactions
Prasugrel clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Prasugrel: Indications, Dosing, Side Effects and Interactions
Prasugrel clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**In combination with aspirin**
- **Adult** (By Mouth): 75 years and over Initially 60 mg for 1 dose, then 5 mg once daily usually for up to 12 months.
**Patients undergoing coronary angiography within 48 hours of admission**
- **Adult** (By Mouth): for unstable angina or NSTEMI Loading dose 60 mg, not to be administered until the time of percutaneous coronary intervention in order to minimise the risk of bleeding, maintenance dose of 10 mg or 5 mg daily should then be selected as appropriate based on age and weight.
Cautions
Body-weight less than 60 kg; discontinue at least 7 days before elective surgery if antiplatelet effect not desirable; elderly; patients at increased risk of bleeding (e.g. from recent trauma, surgery, gastro-intestinal bleeding, or active peptic ulcer disease)
Contraindications
Active bleeding; history of stroke or transient ischaemic attack
Side effects
Common or very common Anaemia; haemorrhage; skin reactions Uncommon Angioedema; hypersensitivity Rare or very rare Thrombocytopenia
Interactions
**Severe interactions:**
- Although not studied in specific interaction studies, Prasugrel has been co-administered in the phase 3 clinical trial with low molecular weight heparin, bivalirudin, and GP IIb/IIIa inhibitors (no...
- Heparin: A single intravenous bolus dose of unfractionated heparin (100 U/kg) did not significantly alter the prasugrel-mediated inhibition of platelet aggregation.
- Likewise, prasugrel did not significantly alter the effect of heparin on measures of coagulation.
- Therefore, CYP3A inhibitors such as azol antifungals, HIV protease inhibitors, clarithromycin, telithromycin, verapamil, diltiazem, indinavir, ciprofloxacin, and grapefruit juice are not anticipated...
- Inducers of cytochromes P450: Rifampicin (600 mg daily), a potent inducer of CYP3A and CYP2B6, and an inducer of CYP2C9, CYP2C19, and CYP2C8, did not significantly change the pharmacokinetics of...
- Therefore, known CYP3A inducers such as rifampicin, carbamazepine, and other inducers of cytochromes P450 are not anticipated to have significant effect on the pharmacokinetics of the active...
- Effects of Prasugrel on other medicinal products Digoxin : Prasugrel has no clinically significant effect on the pharmacokinetics of digoxin.
**Other interactions (23):**
- Warfarin: Concomitant administration of prasugrel with coumarin derivatives other than warfarin has not been studied.
- Because of the potential for increased risk of bleeding, warfarin (or other coumarin derivatives) and prasugrel should be co-administered with caution (see section 4.4).
- Because of the potential for increased risk of bleeding, chronic NSAIDs (including COX-2 inhibitors) and prasugrel should be co-administered with caution (see section 4.4).
- Prasugrel can be concomitantly administered with medicinal products metabolised by cytochrome P450 enzymes (including statins), or medicinal products that are inducers or inhibitors of cytochrome...
- Prasugrel can also be concomitantly administered with ASA, heparin, digoxin, and medicinal products that elevate gastric pH, including proton pump inhibitors and H 2 blockers.
- Effects of other medicinal products on Prasugrel Acetylsalicylic acid : Prasugrel is to be administered concomitantly with acetylsalicylic acid (ASA).
Pregnancy
Manufacturer advises use only if potential benefit outweighs risk.
Breast feeding
Manufacturer advises avoid-no information available.
Hepatic impairment
Manufacturer advises caution in moderate impairment (increased risk of bleeding, limited information available); avoid in severe impairment (no information available).
Renal impairment
Use with caution (increased risk of bleeding, limited information available). M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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