Apagrel

Prasugrel is an inhibitor of platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y12 class of ADP receptors on platelets.

• Coadministration of Prasugrel and warfarin increases the risk of bleeding.
• Coadministration of Prasugrel and NSAIDs (used chronically) may increase the risk of bleeding.
• Prasugrel can be administered with drugs that are inducers or inhibitors of cytochrome P450 enzymes. Prasugrel can be administered with aspirin (75 mg to 325 mg per day), heparin, GPIIb/IIIa inhibitors, statins, and drugs that elevate gastric pH, including proton pump inhibitors and H2 blockers.

• Bleeding
• Thrombotic thrombocytopenic purpura
• Other side effects (Headache, back pain, dyspnea, nausea, hypertension, bradycardia, rash etc)

There are no adequate and well-controlled studies of Prasugrel use in pregnant women. Reproductive and developmental toxicology studies in rats and rabbits at doses of up to 30 times the recommended therapeutic exposures in humans revealed no evidence of fetal harm; however, animal studies are not always predictive of a human response.

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.

• CABG-related bleeding: Risk increases in patients receiving Prasugrel who undergo CABG.
• Discontinuation of Prasugrel: Premature discontinuation increases risk of stent thrombosis, MI, and death

Pediatric Use: Safety and effectiveness in pediatric patients have not been established.

Geriatric Use: Patients > 75 years of age who received Prasugrel had an increased risk of fatal bleeding events (1.0%) compared to patients who received Clopidogrel (0.1%).

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.

Anti-platelet drugs

In rats, lethality was observed after administration of 2000 mg/kg. Platelet transfusion may restore clotting ability. The prasugrel active metabolite is not likely to be removed by dialysis.

Keep in dry place and away from light and heat. Keep out of the reach of children.