Antiplatelet Pregnancy: No clinical study has been conducted in pregnant or breast-feeding women. Animal studies do not indicate direct harmful effects on pregnancy or embryonal/foetal development, but because animal reproduction studies are not always predictive, prasugrel should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the foetus. Use during breast-feeding is not recommended.

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.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Single 60 mg loading dose, then 10 mg once daily maintenance

Route: Oral — with or without food; do not crush or break the tablet

Frequency: Loading dose once, then once daily

Patients taking prasugrel should also take aspirin (ASA) 75 mg to 325 mg daily. In UA/NSTEMI patients where coronary angiography is performed within 48 hours of admission, the loading dose should only be given at the time of PCI. In acute coronary syndrome managed with PCI, premature discontinuation of any antiplatelet agent could increase the risk of thrombosis, myocardial infarction or death; treatment for up to 12 months is recommended unless discontinuation is clinically indicated. Patients aged 75 years and over: use is generally NOT recommended; if treatment is judged necessary after careful individual benefit/risk evaluation, give the 60 mg loading dose followed by a reduced maintenance dose of 5 mg (the 10 mg maintenance dose is not recommended). Patients weighing under 60 kg (source prints '60 kg' with the inequality symbol stripped; §4.4 confirms this refers to body weight below 60 kg): 60 mg loading dose then 5 mg once daily — the 10 mg maintenance dose is not recommended because of increased exposure to the active metabolite and increased bleeding risk. Hepatic impairment: no adjustment in mild to moderate (Child-Pugh A and B), with limited therapeutic experience; contraindicated in severe (Child-Pugh C). Paediatric: safety and efficacy in children under 18 have not been established (limited data in children with sickle cell anaemia). Administration of the 60 mg loading dose in the fasted state may provide the most rapid onset of action.

Dose adjustments

Renal

No dose adjustment is necessary for patients with renal impairment, including patients with end-stage renal disease. Therapeutic experience is limited and these patients may have an increased bleeding risk, so use with caution.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm 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.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Active pathological bleeding
History of stroke or transient ischaemic attack (TIA)
Severe hepatic impairment (Child-Pugh class C)

Side effects

Bleeding — the most common adverse reaction and the leading cause of discontinuation (2.5% in TRITON); non-CABG TIMI major bleeding 2.2% and TIMI minor bleeding 2.4%
Gastrointestinal bleeding — the most common site of spontaneous bleeding (1.7%)
Arterial puncture-site bleeding — the most frequent site of provoked bleeding (1.3%)
Life-threatening bleeding (1.3%), including fatal bleeding (0.3%)
Symptomatic intracranial haemorrhage (0.3%). Bleeding risk is markedly higher in patients aged 75 and over (non-CABG TIMI major or minor bleeding 9.0%, 1.0% fatal, on the 10 mg dose)

Interactions

Medicinal products that increase bleeding risk — oral anticoagulants, clopidogrel, NSAIDs and fibrinolytics; use only where the benefit outweighs the risk of serious bleeding
Warfarin — co-administration increases the risk of bleeding (US label §7.1)
NSAIDs used chronically — may increase the risk of bleeding (US label §7.2)
Opioid agonists (e.g. morphine) — delay and reduce absorption of prasugrel's active metabolite; consider a parenteral antiplatelet agent in ACS patients needing an opioid (US label §7.3)
May be administered with aspirin 75-325 mg/day, heparin, GPIIb/IIIa inhibitors, statins, digoxin and gastric acid-suppressing drugs including PPIs and H2 blockers (US label §7.4)
Note: eMC §4.5 was not captured in this source bundle — the full UK interaction list must be checked against the SPC

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. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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