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Antiplatelet

Prasugrel

Brand names: Efient

Used in: Acute Coronary Syndrome & Chest Pain

Prasugrel is a P2Y12-inhibitor antiplatelet given with aspirin to prevent atherothrombotic events in acute coronary syndrome managed with percutaneous coronary intervention; it is more potent and consistent than clopidogrel but carries a higher bleeding risk.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Initiate prasugrel tablets treatment as a single 60 mg oral loading dose and then continue at 10 mg orally once daily. Patients taking prasugrel tablets should also take aspirin (75 mg to 325 mg) daily [see Drug Interactions (7.4) and Clinical Pharmacology (12.3) ] . Prasugrel tablets may be administered with or without food [see Clinical Pharmacology (12.3) and Clinical Studies (14) ] . Timing of Loading Dose In the clinical trial that established the efficacy and safety of prasugrel tablets, the loading dose of prasugrel tablets was not administered until coronary anatomy was established in UA/NSTEMI patients and in STEMI patients presenting more than 12 hours after symptom onset. In …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-03-02. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It is a prodrug that irreversibly blocks the platelet P2Y12 adenosine diphosphate receptor, inhibiting platelet activation and aggregation.

Prescribing in practice

  • It is contraindicated in patients with a history of stroke or transient ischaemic attack because of an unfavourable bleeding risk.
  • Use with caution in low body weight and in older patients, in whom bleeding risk is increased.
  • Stop before major elective surgery, allowing the SPC-recommended interval, because of the risk of bleeding.

Monitoring

Monitor for signs of bleeding throughout treatment; review haemoglobin if bleeding is suspected and reassess antiplatelet therapy around surgical or invasive procedures.

Counselling the patient

  • Report any unusual bruising or bleeding, including black or bloody stools.
  • Tell doctors and dentists you take prasugrel before any procedure or surgery.
  • Do not stop taking it without advice from your cardiologist, as this raises the risk of a clot.

Evidence & guidelines

Recommended with aspirin for acute coronary syndrome undergoing percutaneous coronary intervention (NICE TA317).

Reference: TRITON-TIMI 38 (Wiviott et al, NEJM 2007); ESC ACS Guidelines 2023; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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