prasugrel

Brand: Effient

⚠ BBW Prototype: clopidogrel

Drug Class: antiplatelet

Drug Family: antiplatelet

Subclass: P2Y12 ADP receptor antagonist (thienopyridine prodrug)

Organ Systems: cardiovascular

Mechanism of Action

Prodrug more efficiently activated than clopidogrel; irreversible P2Y12 blockade; more potent and consistent than clopidogrel; less susceptible to CYP2C19 polymorphism.

P2Y12 ADP receptor

Indications

ACS with planned PCI (TRITON-TIMI 38)

Contraindications

active pathological bleeding
prior stroke/TIA (NET HARM)
age >=75 (relative — higher bleeding risk)
weight <60 kg (relative)
severe hepatic impairment

Adverse Effects

Common

bleeding
rash

Serious

major hemorrhage (greater than clopidogrel)

Pharmacokinetics (ADME)

Absorption	79% absorbed; rapid hydrolysis and CYP3A4/CYP2C19 activation
Distribution	irreversible
Metabolism	hepatic (less CYP2C19 dependent than clopidogrel)
Excretion	renal 68%, fecal 27%
Half-life	7-10 days (platelet lifespan)
Onset	1 hour
Peak	peak 2h
Duration	7-10 days
Protein Binding	98%
Vd	variable

Drug Interactions

Drug / Agent	Mechanism	Severity
warfarin	additive bleeding risk	major
NSAIDs	additive bleeding risk	major

Nursing Considerations

TRITON-TIMI 38: prasugrel superior to clopidogrel in ACS-PCI but higher bleeding risk
AVOID in prior stroke/TIA (net harm), age >=75, or weight <60 kg
More potent and less susceptible to CYP2C19 polymorphism than clopidogrel
Hold 7 days before surgery

Clinical Pearls

More potent antiplatelet effect than clopidogrel: less CYP2C19 dependency
TRITON-TIMI 38: reduced stent thrombosis and CV events but increased fatal bleeding, including intracranial hemorrhage in prior TIA/stroke patients

Safety Profile

Pregnancy avoid

Lactation avoid

Renal Adjustment Not required

Hepatic Adjustment Required

TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

ACS With Planned PCI (TRITON-TIMI 38) Antiplatelet

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