Antiplatelet Pregnancy: Avoid — insufficient data

Prasugrel

Brand names: Efient

Adult dose

Dose: Loading: 60 mg once, then 10 mg once daily (5 mg OD if weight <60 kg or age ≥75 years)

Route: Oral

Frequency: Loading then OD

Max: 60 mg loading; 10 mg OD

For ACS undergoing PCI. Avoid in patients with prior stroke/TIA — absolute contraindication.

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not licensed in children

Not indicated in paediatric patients

Dose adjustments

Renal

No dose adjustment required

Hepatic

Avoid in severe hepatic impairment

Clinical pearls

Irreversible P2Y12 inhibitor; more potent than clopidogrel
TRITON-TIMI 38: reduced MACE vs clopidogrel in PCI-ACS, more bleeding
Avoid in age ≥75 (higher net harm) or prior stroke/TIA (absolute contraindication)
Discontinue 7 days before elective surgery

Contraindications

Active pathological bleeding
Prior stroke or TIA
Age <18 years
Severe hepatic impairment

Side effects

Bleeding (higher rate than clopidogrel)
Anaemia
Dyspnoea
Rash

Interactions

NSAIDs — increased bleeding risk
Warfarin/anticoagulants — increased bleeding
Heparin — monitor closely
Strong CYP3A4 inhibitors — minimal effect (prodrug activation via CYP3A4 and CYP2C19)

Monitoring

Bleeding signs
Haemoglobin
Weight monitoring for dose adjustment

Reference: BNFc; TRITON-TIMI 38 (Wiviott et al, NEJM 2007); BNF; ESC ACS Guidelines 2023. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways