Home Drug Guide Prasugrel Hydrochloride

Drug Guide

Generic Name

Prasugrel Hydrochloride

Brand Names Effient

Classification

Therapeutic: Antiplatelet agent

Pharmacological: P2Y12 ADP receptor antagonist

FDA Approved Indications

Prevention of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) scheduled for percutaneous coronary intervention (PCI)

Mechanism of Action

Prasugrel irreversibly inhibits the P2Y12 class of ADP receptors on platelets, thereby preventing platelet aggregation and reducing clot formation.

Dosage and Administration

Adult: Initial dose of 60 mg orally once, followed by 10 mg once daily; dose adjustments may be necessary based on body weight and bleeding risk.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; dose adjustment may be necessary due to increased bleeding risk in elderly patients.

Renal Impairment: Adjustments recommended; contraindicated in severe impairment.

Hepatic Impairment: Use with caution; no specific dosage recommendations available.

Pharmacokinetics

Absorption: Rapid absorption with peak plasma concentrations within 30 minutes to 1 hour.

Distribution: Extensively bound to plasma proteins (~98%).

Metabolism: Metabolized primarily in the liver via CYP3A4 and CYP2B6 to active metabolites.

Excretion: Excreted mainly in feces (roughly 86%) and urine (about 3%).

Half Life: Approximately 7 hours for the active metabolite.

Contraindications

Active pathological bleeding (e.g., peptic ulcer or intracranial hemorrhage)
Hypersensitivity to prasugrel or excipients

Precautions

History of stroke or transient ischemic attack (TIA); increased risk of intracranial bleeding.
Use caution in patients with bleeding disorders, recent surgery, or severe uncontrolled hypertension.

Adverse Reactions - Common

Bleeding (easy bruising, bleeding at surgical sites) (Very common)
Dyspnea (Less common)

Adverse Reactions - Serious

Major bleeding including intracranial hemorrhage (Less common but serious)

Drug-Drug Interactions

Other antiplatelet agents, anticoagulants, NSAIDs, ssri, SNRI antidepressants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of bleeding, platelet function, and combativeness.

Diagnoses:

Risk for bleeding
Ineffective tissue perfusion

Implementation: Administer as prescribed, monitor laboratory values, educate patient on bleeding precautions.

Evaluation: Assess for bleeding signs, efficacy in preventing thrombotic events, and adverse reactions.

Patient/Family Teaching

Report any unusual bleeding or bruising.
Do not discontinue medication without consulting healthcare provider.
Use caution with activities that may increase bleeding risk.
Inform about signs of bleeding and when to seek medical attention.

Special Considerations

Black Box Warnings:

Major bleeding risk; contraindicated in patients with history of TIA or stroke.

Genetic Factors: Genetic variability in CYP2B6 and CYP3A4 enzymes may affect metabolism.

Lab Test Interference: May prolong bleeding time; no specific lab test for direct measurement.

Overdose Management

Signs/Symptoms: Profuse bleeding, anemia, hypotension.

Treatment: Discontinue prasugrel, provide supportive care, consider blood product transfusions, and manage bleeding in accordance with standard protocols.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable up to the expiration date on the package when stored properly.