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Pharmacologic class: Thienopyridine platelet inhibitor
Therapeutic class: Antiplatelet drug
Pregnancy risk category B
FDA Box Warning
• Drug can cause significant, sometime fatal, bleeding.
• Don't use in patients with active pathological bleeding or history of transient ischemic attack or stroke (patients age 75 and older).
• Drug is generally not recommended, because of increased risk of fatal and intracranial bleeding and uncertain benefit. In high-risk situations (such as patients with diabetes or history of prior myocardial infarction, where its effect appears to be greater), its use may be considered.
• Don't start drug in patients likely to undergo urgent coronary artery bypass graft (CABG). If possible, discontinue drug at least 7 days before any surgery.
• Additional risk factors for bleeding include body weight of less than 132 lb (60 kg), propensity for bleeding, concomitant use of medications that increase bleeding risk (such as warfarin, heparin, fibrinolytics, and nonsteroidal anti-inflammatory drugs [prolonged use]). Suspect bleeding in patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention (PCI), CABG, or other surgical procedures.
• If possible, manage bleeding without discontinuing drug. Discontinuing drug, particularly in first few weeks after acute coronary syndrome, increases risk of subsequent cardiovascular events.
Inhibits platelet activation and aggregation through irreversible binding of its active metabolite to the P2Y12 class of adenosine diphosphate receptors on platelets
Tablets: 5 mg, 10 mg
⊘Indications and dosages
➣ Reduction of rate of thrombotic cardiovascular events in patients with acute coronary syndrome who are to be managed with PCI as follows: patients with unstable angina or non-ST-elevation myocardial infarction (MI) and patients with ST-elevation MI when managed with primary or delayed PCI
Adults: Initially, 60 mg P.O. as loading dose; then, 10 mg P.O. daily (with aspirin 75 to 325 mg daily)
• Adults weighing less than 132 lb
• Hypersensitivity to drug or its components
• Active pathological bleeding
• History of transient ischemic attack or cerebrovascular accident
Use cautiously in:
• CABG-related bleeding, patients at general risk for bleeding
• thrombotic thrombocytopenia purpura
• low body weight (less than 132 lb)
• elderly patients age 75 and older (use not recommended except in high-risk situations, such as diabetes and history of MI)
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
• Administer with or without food.
☞ Be aware that premature drug discontinuation increases risk of stent thrombosis, MI, and death.
CNS: headache, dizziness, fatigue, intracranial hemorrhage
CV: hypertension, hypotension, bradycardia, peripheral edema, atrial fibrillation
GI: nausea, diarrhea, GI hemorrhage
Hematologic: leukopenia, bleeding, life-threatening bleeding, thrombotic thrombocytopenia purpura
Metabolic: hypercholesterolemia, hyperlipidemia
Musculoskeletal: back pain, extremity pain
Respiratory: dyspnea, cough
Other: chest pain, pyrexia, newly diagnosed malignancies
Drug-drug.Nonsteroidal anti-inflammatory drugs, warfarin: increased risk of bleeding
Drug-diagnostic tests.Cholesterol, lipids: increased levels
White blood cells: decreased count
☞ Closely monitor coagulation studies and CBC with white cell differential and watch for evidence of bleeding.
• Monitor cholesterol and lipid levels closely.
• Instruct patient to take drug with or without food.
☞ Instruct patient to immediately report to prescriber blood in stool or urine or unanticipated, prolonged, or excessive bleeding.
☞ Instruct patient to promptly report to prescriber if fever, weakness, extreme skin paleness, purple skin patches, or neurologic changes, such as dizziness or headache, occur.
• Advise patient to notify all health care professionals that he's taking prasugrel.
• Advise patient not to take other prescription or nonprescription drugs or dietary supplements without first discussing with prescriber.
• Caution patient not to discontinue drug without first discussing with prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
ClassificationTherapeutic: antiplatelet agents
Time/action profile (effect on platelet function)
|PO||within 1 hr||2 hr||5–9 days†|
Adverse Reactions/Side Effects
Central nervous system
- atrial fibrillation
- peripheral edema
- bleeding (life-threatening)
- thrombotic thrombocytopenic purpura (life-threatening)
- back pain
- extremity pain
- allergic reactions including angioedema (life-threatening)
- non-cardiac chest pain
Drug-Drug interaction↑ risk of bleeding with warfarin and NSAIDs.
Route/DosageAspirin 75–325 mg/daily should be taken concurrently
- Assess patient for symptoms of stroke, peripheral vascular disease, or MI periodically during therapy.
- Monitor patient for signs of thrombotic thrombocytic purpura (thrombocytopenia, microangiopathic hemolytic anemia, neurologic findings, renal dysfunction, fever). May rarely occur, even after short exposure (<2 wk). Requires prompt treatment.
- Lab Test Considerations: Monitor bleeding time during therapy. Prolonged bleeding time, which is time- and dose-dependent, is expected.
- Monitor CBC with differential and platelet count periodically during therapy. Thrombocytopenia and anemia may rarely occur.
Potential Nursing DiagnosesRisk for injury (Indications, Side Effects)
- Discontinue prasugrel 7 days before planned surgical procedures.
- Patients should take aspirin 75–325 mg daily with prasugrel.
- Oral: Administer once daily without regard to food.
- Instruct patient to take medication as directed. Take missed doses as soon as possible unless almost time for next dose; do not double doses. Do not discontinue without consulting health care professional. Advise patient to read Medication Guide before taking and with each Rx refill; new information may be available.
- Advise patient to notify health care professional promptly if fever, weakness, skin paleness, purple skin patches, yellowing of skin or eyes, chills, sore throat, neurological changes, or unusual bleeding or bruising, swelling of lips, difficulty breathing, rash, or hives occurs.
- Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially NSAIDs.
- Prevention of stroke, MI, and vascular death in patients at risk.