PrasugrelPrasugrel Hydrochloride

About Prasugrel

Prasugrel is a thienopyridine, like clopidogrel: it keeps platelets from clumping into a clot. The label approves it to reduce thrombotic cardiovascular events, including stent thrombosis, in adults with acute coronary syndrome (unstable angina, NSTEMI or STEMI) who are managed with percutaneous coronary intervention (PCI). Treatment starts with a single 60 mg loading dose and continues at 10 mg once a day, taken together with aspirin 75 to 325 mg daily. For people who weigh less than 60 kg (about 132 pounds), the label says to consider lowering the daily dose to 5 mg.

The boxed warning says prasugrel can cause significant, sometimes fatal, bleeding. It must not be used by anyone with active pathological bleeding (such as a bleeding peptic ulcer or bleeding in the brain), anyone who has had a stroke or transient ischemic attack (TIA), or anyone allergic to prasugrel or an ingredient. Use in people 75 or older is generally not recommended because of the risk of fatal and brain bleeding, except in high risk situations such as diabetes or a prior heart attack. It should not be started in someone likely to need urgent bypass surgery (CABG), and when possible it is stopped at least 7 days before any surgery. Other warnings cover thrombotic thrombocytopenic purpura (TTP), a serious blood disorder that can appear after less than two weeks of use, and allergic reactions, including in people who reacted to clopidogrel. Bleeding, including nosebleeds, is the most common side effect; others include headache, back pain, shortness of breath, nausea and dizziness.

What is distinctive is the danger of stopping early. The label warns that stopping prasugrel too soon raises the risk of stent thrombosis, heart attack and death, so lapses in therapy should be avoided, and bleeding is managed without stopping the drug when possible. Cuts will take longer than usual to stop bleeding, and every doctor and dentist should know about prasugrel before a procedure. The tablets are not scored and are not to be broken. The label has no data on use in pregnancy or on prasugrel in human milk, so benefits and risks are weighed with the prescriber. Each fill comes with a Medication Guide. Prasugrel is not a controlled substance.

Taking Prasugrel

How to take it

Take one tablet once a day at about the same time, with or without food, along with the aspirin your prescriber directs. Swallow it whole, and do not stop without talking to the prescriber.

If you miss a dose

Take the missed dose as soon as you remember, unless it is almost time for the next one; then skip it and continue your usual schedule. Do not take a double dose.

Storage

Keep the tablets tightly closed in the original container with the desiccant inside, at room temperature (25 degrees C, 77 degrees F), away from heat and moisture and out of reach of children. Use a take-back program for unneeded tablets.

Interactions to know about

Warfarin raises the bleeding risk, and regular use of NSAIDs such as ibuprofen or naproxen may too. The label notes that opioids such as morphine can delay and reduce prasugrel’s effect. Tell the pharmacist about every medicine and supplement you use.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Prasugrel differs from pharmacy to pharmacy

Prasugrel is a multisource generic, so most quotes are for a generic tablet and differ with the maker the pharmacy buys from, whether it keeps prasugrel on the shelf or orders it in, and its own cash pricing. A pharmacy that has to order it in may quote differently from one that stocks it. A prescription written for Effient with substitution blocked is priced as a brand and costs far more than a generic.

Both strengths come in bottles of 30 tablets with a desiccant, and the label says to keep them in the original container, so a quote is usually for whole bottles. On a single month’s fill the dispensing fee is a noticeable share of the quote.

Ways to pay less for Prasugrel without insurance

• Ask the prescriber to write the generic name, prasugrel, and allow substitution, since therapeutically equivalent generics can be dispensed in place of Effient.
• Call ahead or compare quotes from more than one pharmacy, since a pharmacy may need to order it in, and refill early enough that you never run out.
• Once the dose is settled, ask the prescriber whether a ninety-day supply is appropriate.
• Ask whether prasugrel is on a pharmacy’s flat-price generic list.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Prasugrel

1. 1.Is my tablet a generic rated as equivalent to Effient, and will it look different between refills?
2. 2.Which pain relievers are safe for me to use with prasugrel and my aspirin?
3. 3.What bleeding signs mean I should call my doctor or get emergency care?
4. 4.If I need dental work or surgery, who decides whether I should pause my prasugrel?

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