Prasugrel (Oral)

Prasugrel is an oral medication prescribed by doctors for the prevention of heart attacks, strokes or other serious complications involving the blood vessels or the heart prior to surgical intervention.

Overview

What is Prasugrel?

Prasugrel, also known under the marketing name of Effient, is a platelet inhibitor that is used to prevent blood clots, especially during surgical procedures involving the heart. Approved for use since 2009, Prasugrel is also effective in preventing strokes and other serious complications from happening during a procedure known as PCI or percutaneous coronary intervention.

How does Prasugrel work?

Prasugrel works by hooking on to a protein found on the surface of a blood cell and preventing it from clotting or clumping with other blood cells. Prasugrel is a prodrug, which means it must be taken in by the body and go through the metabolization process to turn into an active drug, it cannot be injected or taken any other way but orally. This type of drug has a reduced chance of unwanted effects that could happen with other drugs.

What is PCI?

The coronary arteries in the hearts of some patients have been narrowed by plaque build-up or other issues. This reduces the blood flow and can affect how the heart works, eventually leading to a heart attack, stroke or other conditions.

PCI is a procedure used to treat these narrow arteries that is considered to be non-surgical. The surgeon enters the blood stream through a main artery in the groin or chest and uses a catheter to show the vessels in the heart as an x-ray image. A specialist called an interventional cardiologist takes over using a catheter with a balloon that is moved into the narrowed artery and is inflated to open the passage back up. Occasionally a stent device will be inserted to open the blood vessel and sometimes other procedures are performed at the same time.

Both during and after this procedure, patients are at risk for experiencing blood clotting. In addition to aspirin therapy, most PCI patients are also prescribed an anti-clotting drug such as Prasugrel as a precaution against heart attacks, strokes and other complications post surgery.

Conditions Treated

  • PCI procedure
  • Heart attack
  • Unstable angina

Type Of Medicine

ADP receptor inhibitor

Side Effects

Prasugrel may cause bothersome ill effects to your health such as:

  • Dizziness
  • Nervousness
  • Headache
  • Blurred vision
  • Pounding in ears
  • Rapid heart rhythm
  • Stools that appear tar-like or black
  • Swollen lower legs, feet, face, hands or arms
  • Pain or discomfort in chest
  • Coughing
  • Chills or fever
  • Strained breathing
  • Passing out
  • Irregular heart rhythm
  • Feeling light headed
  • Urination that is difficult or painful
  • Gaining weight rapidly
  • Throat soreness
  • White spots, ulcers or sores in mouth or on lips
  • Glands that are swollen
  • Feet or hands tingling
  • Chest feels tight
  • Bruises or bleeding that is unexplained
  • Fatigue or weak muscles
  • Loss or gain of weight without explanation
  • Mental state changes
  • Urine that is dark or shows blood
  • Speaking difficulty
  • Elevated temperature
  • Skin paleness
  • Tiny red dots on skin
  • Seizures
  • Weak muscles
  • Skin or eyes appear yellow

Mild side effects are those that do not require medical attention but may make you uncomfortable. After treatment with Prasugrel, these effects may disappear. Your health care provider can advise you on the best ways to deal with these side effects, so check with your cardiac team if you experience:

  • Nausea
  • Diarrhea
  • Painful legs or arms
  • Skin rashes
  • Back pain

Other side effects may still occur in some patients, which should always be reported to your doctor. Any changes to your health should prompt you to notify your physician in case they are a sign of an unwanted effect from Prasugrel treatment.

Dosage

Your doctor will provide you with written information about your prescription of Prasugrel as well as any information from the manufacturer. Read and understand all information prior to taking Prasugrel and ask questions to provide clarity on any instructions you aren't sure about.

The prescription of Prasugrel will vary for different patients, so the information provided is a general dosage guideline. Always follow what your doctor has prescribed. Do not vary the amount, the times you are supposed to take your doses or the length of time of your prescription as written by your physician.

Adults over 60 kilograms are typically prescribed 60 milligrams as an initial dose followed by 10 milligram doses once per day. Typically Prasugrel is prescribed with a dose of aspirin of 75 to 325 milligrams once daily as well.

Those patients who weigh less than 60 kilograms will most likely be prescribed the 60 milligram initial dose followed by a 5 milligram dose amount once per day.

Use of this medication in pediatric patients must be determined by health care professionals.

Do not double dose if you miss a dose of Prasugrel in favor of resuming your dosing schedule routine. If you remember soon enough, however, take the missing dose as long as it isn't too close to your next dose time.

Interactions

Hypersensitivity to other drugs or to Prasugrel in the past should be something that you notify your physician about before taking this drug. Allergies to pet dander, animals, dyes, perfumes, additives or preservatives should also be communicated to your physician.

Data on safety and effective use on pediatric patients has not been provided by any medical system. Use of Prasugrel in this age group should be under caution only.

Geriatric patients older than 75 should not receive a dose of Prasugrel under any circumstances as the drug has a high risk of toxicity in this age group.

Data pertaining to pregnant women or those who are breastfeeding with regard to being treated with Prasugrel has not been provided. If you are pregnant or nursing, inform your physician prior to receiving this drug.

Some medications must be prescribed together to provide maximum health benefits to patients, depending on their condition and other factors. Other medications can be dangerous or ineffective when combined. If you are taking the following medication, inform your physician:

  • Defibrotide

Your physician may decide not to prescribe Prasugrel or may change your dose of this medication, depending on your condition.

The following medicines are usually not recommended for use with Prasugrel, but the combination may be required by your health condition. Inform your physician if you currently take:

  • Acemetacin
  • Aceclofenac
  • Alteplase, Recombinant
  • Alipogene Tiparvovec
  • Anagrelide
  • Amtolmetin Guacil
  • Ardeparin
  • Apixaban
  • Aspirin
  • Argatroban
  • Bivalirudin
  • Bemiparin
  • Bufexamac
  • Bromfenac
  • Celecoxib
  • Bupropion
  • Choline Salicylate
  • Certoparin
  • Citalopram
  • Cilostazol
  • Dabigatran Etexilate
  • Clonixin
  • Danaparoid
  • Dalteparin
  • Dexibuprofen
  • Desirudin
  • Diclofenac
  • Dexketoprofen
  • Dipyridamole
  • Diflunisal
  • Droxicam
  • Dipyrone
  • Enoxaparin
  • Edoxaban
  • Escitalopram
  • Eptifibatide
  • Etofenamate
  • Etodolac
  • Felbinac
  • Etoricoxib
  • Fepradinol
  • Fenoprofen
  • Floctafenine
  • Feprazone
  • Fluoxetine
  • Flufenamic Acid
  • Fluvoxamine
  • Flurbiprofen
  • Heparin
  • Fondaparinux
  • Indomethacin
  • Ibuprofen
  • Ketorolac
  • Ketoprofen
  • Levomilnacipran
  • Lepirudin
  • Loxoprofen
  • Lornoxicam
  • Meclofenamate
  • Lumiracoxib
  • Meloxicam
  • Mefenamic Acid
  • Nabumetone
  • Morniflumate
  • Naproxen
  • Nadroparin
  • Nepafenac
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Nefazodone
  • Niflumic Acid
  • Oxyphenbutazone
  • Oxaprozin
  • Parnaparin
  • Parecoxib
  • Phenindione
  • Paroxetine
  • Phenylbutazone
  • Phenprocoumon
  • Piracetam
  • Piketoprofen
  • Proglumetacin
  • Piroxicam
  • Proquazone
  • Propyphenazone
  • Reviparin
  • Protein C
  • Rofecoxib
  • Rivaroxaban
  • Salsalate
  • Salicylic Acid
  • Sodium Salicylate
  • Sertraline
  • Tenoxicam
  • Sulindac
  • Tinzaparin
  • Tiaprofenic Acid
  • Tolmetin
  • Tolfenamic Acid
  • Vilazodone
  • Valdecoxib
  • Warfarin
  • Vortioxetine

Your physician will also want to be made aware if you take the following drug, as one or both drugs may need to be adjusted to suit your condition:

  • Ritonavir

Consult with your doctor in regards to the use of tobacco products, consumption of alcoholic beverages and use of illegal drugs, as the combination of these substances with Prasugrel can be harmful to your health. For safety reasons, inform your physician of all medications you currently take as well as any vitamin, over-the-counter, herbal, holistic or other remedies.

Your full health history, when provided to your physician, can be helpful in determining if you will be safe to take Prasugrel or not. Occasionally some medical conditions can be made worse by taking this drug. Inform your health care provider if you suffer from the following conditions:

  • Stroke
  • Bleeding conditions in any part of the body
  • TIA or mini-stroke
  • Allergy to Plavix or Ticlid
  • Kidney disease
  • Insufficient weight (less than 132 pounds)
  • Liver disease
  • Bleeding bowel or stomach
  • Ulcers
  • Surgery such as heart bypass, angiograpy or other PCI procedures
  • Recent trauma

Warnings

Your physician will want regular progress reports on your health condition, which will require you to pay visits in person to his office for various urine tests or blood samples. Be sure to keep all appointments with your doctor so that you can be monitored for the effectiveness of Prasugrel as well as the safety to your health.

Patients older than 75 years of age have been proven to be more sensitive to the unwanted health effects this drug can cause. Avoid use of this drug if you are in this age group.

Avoid aggressive sports and use caution when using sharp implements such as razors or nail cutters as your chances for severe bruising and excessive bleeding and injury are heightened during treatment with Prasugrel.

Inform any other physicians including dentists that you are under treatment with Prasugrel, as you may be prone to abnormal bleeding during even routine procedures such as dental cleanings. If you need to have a procedure or an operation, you must stop taking Prasugrel seven days before the procedure and inform the prescribing physician of this.

If you experience mental changes, blood in your urine, dark colored urine, trouble speaking, pale skin, fever, tiny red spots on your skin, weak muscles, seizures or a yellow tinge to your skin or eyes, report these symptoms immediately. You could have experienced a severe health condition known as TTP or thrombotic thrombocytopenic purpura.

Hypersensitive reactions such as angioedema, a life-threatening condition, require emergency medical attention. Be aware of the symptoms of angiodema, which include skin rashes and itching, swollen facial features or throat, difficulty breathing or swallowing and chest pain while using Prasugrel.

Check with your doctor before you stop taking Prasugrel, as you may increase your risk of blood clots and other complications. Avoid other medications during your treatment unless specifically prescribed with this medication by your doctor.

Limit your consumption of alcoholic beverages while taking Prasugrel, as the risk for bleeding stomach conditions is increased when the two are combined. Your physician or pharmacist can advise you on a safe amount of alcohol to consume while taking this drug.

Storage

Retain the original packaging that your Prasugrel arrived in and use it to store this medication properly. Keep this medicine at room temperature, away from exposure to excessive light, heat or moisture. Do not allow Prasugrel to freeze and do not use it if it has frozen. This medication, as well as others, should be kept out of sight and reach of children and pets.

Expired or unused Prasugrel dosages should be disposed of properly according to your physician's instructions for safety. If this is not provided to you by your physician, consult with your pharmacist on safe disposal practices.

Summary

Prasugrel is an anti-clotting medication used to prevent blood clots, heart attacks, strokes and other cardiovascular health events during a cardiac procedure known as PCI, among others. PCI, percutaneous coronary intervention, is a procedure where a catheter is fed through the main artery to the heart and used to image the vessels on x-ray. These images assist an interventional cardiologist in determining where to employ balloon therapy to open narrowed vessels and perhaps insert stent apparatus to keep them open. Other procedures may be performed at this time as well.

During and after PCI, it is important to keep the patient from experiencing blood clots that can cause health complications or even become fatal. Drugs such as Prasugrel are used before and after surgery to prevent these health complications. Often, Prasugrel is prescribed with aspirin. By bonding with a protein found on the surface of blood cells, Prasugrel prevents them from clotting together and causing these health complications.

Side effects vary by patient but any effects on health should be communicated to your team of medical professionals right away in case they are serious in nature. Specifically, side effects that indicate a condition known as TTP, thrombotic thrombocytopenic purpura, should be communicated right away. Hypersensitivity to the drug itself should also be disclosed to your doctor. Do not have other surgical procedures or dentistry performed while being treated with Prasugrel without informing all health care providers that you are taking this medication.

Prasugrel should not be prescribed to patients older than 75 years of age as it has been known to be more toxic to this age group in general. Children, women who are pregnant and breastfeeding women should only be prescribed Prasugrel under cautious, extreme circumstances, if at all. Always inform your doctor of your medical history and any medications, whether prescribed or not, that you are taking. Limit alcohol intake during treatment with this drug as it could heighten the risk for bleeding stomach conditions.