- Patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI).
- Patients with ST-elevation myocardial infarction (STEMI) when managed with primary or delayed PCI.
Dosage & Administration
In patients with acute coronary syndrome (ACS) who are managed with PCI, premature discontinuation of any antiplatelet agent, including Prasugrel, could result in an increased risk of thrombosis, myocardial infarction or death due to the patient’s underlying disease. A treatment of up to 12 months is recommended, unless the discontinuation of Prasugrel is clinically indicated.
In case of patients weighing ≤ 60 kg or patient’s ≥ 75 years old, Prasugrel should be given as a single 60 mg loading dose and then continued at a 5 mg once-daily dose.
Pregnancy & Lactation
It is not known whether Prasugrel is excreted in human milk. Because many drugs are excreted in human milk, prasugrel should be used during nursing only if the potential benefit to the mother justifies the potential risk to the nursing infant.
Age ≥ 75 years: Because of the risk of bleeding (including fatal bleeding) and uncertain effectiveness in patients ≥ 75 years of age, use of Prasugrel is generally not recommended in these patients, except in high-risk situations (patients with diabetes or history of myocardial infarction) where its effect appears to be greater and its use may be considered.
Propensity to bleed (e.g., recent trauma, recent surgery, recent or recurrent gastrointestinal (GI) bleeding, active peptic ulcer disease, or severe hepatic impairment): Prasugrel should be used with caution.
Coronary Artery Bypass Graft surgery related bleeding: The risk of bleeding is increased in patients receiving Prasugrel who undergo CABG. If possible, Prasugrel should be discontinued at least 7 days prior to CABG. Do not start Prasugrel in patients likely to undergo urgent CABG.
Discontinuation of Prasugrel: Discontinue thienopyridines, including Prasugrel, for active bleeding, elective surgery, stroke, or TIA.
Use in Special Population
Geriatric Use: The use of Prasugrel in patients ≥75 years of age is generally not recommended because these patients are at greater risk of bleeding, including fatal bleeding, compared to patients <75 years of age. If prescribed, a lower maintenance dose of 5 mg should be used.
Renal Impairment: No dosage adjustment is necessary for patients with renal impairment. There is limited experience in patients with end-stage renal disease
Hepatic Impairment: No dosage adjustment is necessary in patients with mild to moderate hepatic impairment.