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Prasugrel Tablets (Effient(TM))
By William T. Elliott, MD, FACP, and James Chan, PharmD, PhD . Dr. Elliott is Chair, Formulary Committee, Northern California Kaiser Permanente; and Assistant Professor of Medicine, University of California, San Francisco. Dr. Chan is Pharmacy Quality and Outcomes Manager, Kaiser Permanente, Oakland, CA. Drs. Elliott and Chan report no financial relationship to this field of study.
A new antiplatelet drug has been approved by the FDA for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention. Prasugrel is a thienopyridine platelet P2Y 12 adenosine-diphosphate receptor blocker similar to clopidogrel and ticlopidine. The drug is a potent and irreversible inhibitor of platelet aggregation and is positioned to challenge clopidogrel in this billion dollar plus market. It is marketed by Daiichi Sankyo, Inc., and Eli Lilly and Company as Effient(TM).
Indications
Prasugrel is indicated for the reduction of thrombotic cardiovascular events in patients with acute coronary syndrome who are to be managed with percutaneous coronary intervention (PCI). These include patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) and patients with ST-elevation myocardial infarction (STEMI) when managed with either primary or delayed PCI. 1
Dosage
The initial loading dose is 60 mg followed by 10 mg once daily. A lower dose (5 mg) should be considered for patients weighing less than 60 kg. Prasugrel may be taken without regard to meals. No dosage adjustment is required for patients with renal impairment or mild-to-moderate hepatic impairment. 1
Prasugrel is available as 5 mg and 10 mg tablets.
Potential Advantages
Prasugrel is a more potent inhibitor of platelet aggregation than clopidogrel and appears more effective in reducing primary cardiovascular events and...