prasugrel
Prasugrel (also known by its brand name Effient) is a medication that's used as a blood thinner to prevent blood clots in people who have a stent placed in their heart after a heart attack. This medication is also available as a lower-cost generic tablet. The dose is taken once per day. Since prasugrel (Effient) is a blood thinner, an important warning to note is that the medication can make it easier for you to bleed or bruise. Other side effects can include high blood pressure, high cholesterol, and headache.
What is Prasugrel (Effient)?
What is Prasugrel (Effient) used for?
Prevention of blood clot problems in people who received a stent after a heart attack
How Prasugrel (Effient) works
Prasugrel (Effient) is a type of antiplatelet medication called a P2Y12 inhibitor. It works by preventing your platelets from clumping up together and forming blood clots that could potentially travel to your heart or brain. This lowers your risk for a heart attack or stroke.
Drug Facts
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What are the side effects of Prasugrel (Effient)?
Common Side Effects
- High blood pressure (8%)
- High cholesterol (7%)
- Headache (6%)
- Bleeding of any kind (5%)
- Back pain (5%)
- Shortness of breath (5%)
- Nausea (5%)
- Dizziness (4%)
- Cough (4%)
- Low blood pressure (4%)
- Fatigue (4%)
Other Side Effects
- Chest pain
- Pain in arms or legs
- Diarrhea
- Rash
- Fever
Serious Side Effects
- Severe bleeding: feeling faint, lightheaded, dizziness, vomiting or coughing up blood, bloody or dark-colored stools, severe stomach pain or discomfort
- Blood-clotting problem: headache; confusion; dizziness; tiredness; fever; small, purple spots on the skin; bruising; stomach pain; trouble breathing
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred vision
dizziness
headache
nervousness
pounding in the ears
slow or fast heartbeat
Less common
Black, tarry stools
bloating or swelling of the face, arms, hands, lower legs, or feet
chest pain or discomfort
chills
difficult or labored breathing
fainting
irregular heartbeat
lightheadedness, dizziness, or fainting
painful or difficult urination
rapid weight gain
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
tightness in the chest
tingling of the hands or feet
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain or loss
Incidence not known
Change in mental status
dark or bloody urine
difficulty with speaking
pale color of the skin
pinpoint red spots on the skin
seizures
weakness
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Prasugrel (Effient)
Pros
Works well at preventing clots
Works better than clopidogrel (Plavix) to lower your risk of complications after a heart attack
Taken by mouth once per day
Available as a lower-cost generic
Cons
Has a higher risk of bleeding than clopidogrel (Plavix)
Only used for people who have a stent in their heart
Not recommended for people age 75 years and older because of the higher risk of bleeding
Shouldn't use for people with a history of stroke or transient ischemic attack ((TIA or "mini-stroke")
Pharmacist tips for Prasugrel (Effient)
Take prasugrel (Effient) with or without food. Taking it with food might help if it's hurting your stomach. Take prasugrel (Effient) at the same time every day.
Prasugrel (Effient) can make you bleed more easily. Get medical help right away if you feel lightheaded, dizzy, are vomiting or coughing up blood, or have blood in your stool. These are signs of bleeding that might be happening inside your body.
Get medical help as soon as possible if you fall and hit your head while you're taking prasugrel (Effient). Your provider will want to check to make sure you don't have any brain bleeds.
Tell your provider and pharmacist about all of the medications (prescription, over the counter, and supplements) that you're taking or planning on taking with prasugrel (Effient). They can make sure your medications are as safe for you as possible. Prasugrel (Effient) can interact with many medications, such as ibuprofen (Advil), opioid pain medications, and warfarin (Coumadin). These interactions can either make prasugrel (Effient) not work as well or raise your risk for bleeding.
Speak to your provider or a nutritionist to come up with a heart-healthy diet and exercise plan to follow while you're taking prasugrel (Effient). This can help further lower your risk for another heart attack.
Don't stop taking prasugrel (Effient) unless your provider says it's safe for you to do so. Stopping the medication too early can raise your risk of blood clots forming in your body, which can potentially lead to serious and life-threatening complications. If you would like to stop prasugrel (Effient) or switch to another blood thinner, ask your provider how to do so safely.
Frequently asked questions about Prasugrel (Effient)
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What are the risks and warnings for Prasugrel (Effient)?
Prasugrel (Effient) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Bleeding
Risk factors: Taking other medications that raise the risk for bleeding (e.g., antiplatelets, anticoagulants, NSAIDs, corticosteroids)| Bleeding problems | Kidney or liver problems | Recent or upcoming surgery | Age 75 years or older | Weigh less than 132 lbs
Prasugrel (Effient) is a blood thinner, so it raises your risk for bleeding. It can also make it take longer than usual for bleeding to stop. You might also notice that you get bruises more easily or have more bleeding when you get a cut or nosebleed.
Make sure to tell your provider if you're taking other medications that can cause bleeding. Additionally, tell your provider if you're scheduled for any surgery or procedure because you might need to stop prasugrel (Effient) 7 days before.
Tell your provider right away if you notice any abnormal bleeding, see any blood in your stool or urine, cough up blood, or feel dizzier. Get medical help right away if you have a fall, head injury, or other kinds of physical injury since you might have bleeding inside your body. And contact your provider right away if you have dark or tarry stool or bleeds that are hard to stop.
Risk of heart attack if stopped suddenly or too early
Risk factors: Stopping prasugrel (Effient) suddenly or too early | Recent heart attack or stent placement
Don't stop taking prasugrel (Effient) unless your provider specifically tells you it's safe to do so. Stopping the medication too early can raise your risk of getting blood clots. This in turn can raise your risk for heart attack or stroke. Contact your provider so they can create a safe plan for you if you want to stop prasugrel (Effient).
Blood-clotting problem called thrombotic thrombocytopenic purpura (TTP)
Sometimes, prasugrel (Effient) can cause a rare, life-threatening blood condition called thrombotic thrombocytopenic purpura (TTP). This happens when blood clots form in small blood vessels. Sometimes, this blood-clotting condition can happen within the first 2 weeks of starting prasugrel (Effient). Get medical help right away if you have fever, unusual bleeding, easy bruising, headache, weakness, tiredness, trouble breathing, or confusion. You should get treated for this problem as soon as you can.
Allergic reaction
Risk factors: Allergy to prasugrel (Effient) or Brilinta (ticagrelor)
Allergic reactions to prasugrel (Effient) are possible, including life-threatening reactions like facial swelling and anaphylaxis. If you're allergic to clopidogrel (Plavix) or Brilinta (ticagrelor), you might also be allergic to prasugrel (Effient). Stop taking prasugrel (Effient) and call your provider if you notice a rash or hives after taking this medication. Get medical help right away if you have trouble breathing or swelling in your face, throat, or tongue.
Prasugrel (Effient) dosage forms
Typical dosing for Prasugrel (Effient)
The typical dose is 10 mg by mouth once daily. For people weighing less than 132 lbs, your provider might consider prescribing a dose of 5 mg once daily to lower your risk of bleeding.
For people who are in the hospital right after a heart attack, a single 60-mg loading dose is given first before starting the 10-mg usual daily dose.
Interactions between Prasugrel (Effient) and other drugs
More on Prasugrel (Effient) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Defibrotide
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aceclofenac
- Acemetacin
- Alipogene Tiparvovec
- Alteplase, Recombinant
- Amtolmetin Guacil
- Anagrelide
- Apixaban
- Ardeparin
- Argatroban
- Aspirin
- Bemiparin
- Betrixaban
- Bivalirudin
- Bromfenac
- Bufexamac
- Caplacizumab-yhdp
- Celecoxib
- Certoparin
- Choline Salicylate
- Cilostazol
- Citalopram
- Clonixin
- Dabigatran Etexilate
- Dalteparin
- Danaparoid
- Desirudin
- Desvenlafaxine
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyridamole
- Dipyrone
- Droxicam
- Edoxaban
- Enoxaparin
- Eptifibatide
- Escitalopram
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Heparin
- Ibrutinib
- Ibuprofen
- Indomethacin
- Inotersen
- Ketoprofen
- Ketorolac
- Lepirudin
- Levomilnacipran
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Morniflumate
- Nabumetone
- Nadroparin
- Naproxen
- Nefazodone
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Parnaparin
- Paroxetine
- Phenindione
- Phenprocoumon
- Phenylbutazone
- Piketoprofen
- Piracetam
- Piroxicam
- Proglumetacin
- Propyphenazone
- Proquazone
- Protein C
- Reviparin
- Rivaroxaban
- Rofecoxib
- Salicylic Acid
- Salsalate
- Selumetinib
- Sertraline
- Sodium Salicylate
- Sulindac
- Tenoxicam
- Tiaprofenic Acid
- Ticagrelor
- Tinzaparin
- Tolfenamic Acid
- Tolmetin
- Trazodone
- Valdecoxib
- Vilazodone
- Vortioxetine
- Warfarin
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Prasugrel (Effient) cost?
Prasugrel (Effient) contraindications
Active bleeding
History of stroke or transient ischemic attack (TIA or "mini-stroke")
What are alternatives to Prasugrel (Effient)?
Prevention of blood clot problems in people who received a stent after a heart attack
Heart attack prevention
Stroke prevention
Lowering the risk of heart-related death, heart attack, and stroke in people with acute coronary syndrome (ACS) or who've had a previous heart attack
Lowering the risk of a first-time heart attack or stroke in high-risk people with coronary artery disease (CAD)
Lowering the risk of stroke in people who've had a previous stroke or a high-risk transient ischemic attack (TIA) (also called "mini stroke")
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References
Best studies we foundAmerican Heart Association. (2023). What is a stent?
American Red Cross. (n.d.). Platelets and thrombocytopenia.
Aurobindo Pharma Limited. (2024). Prasugrel tablet, film coated [package insert]. DailyMed.
Gutierrez, J. J., et al. (2023). Perioperative Anticoagulation Management. Statpearls.
Khan, S. U., et al. (2020). Dual antiplatelet therapy after percutaneous coronary intervention and drug-eluting stents. Circulation.
Krishnamurthy, A., et al. (2019). Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention. Open Heart.
Mukherjee, D. (2016). ACC/AHA guideline update on duration of dual antiplatelet therapy in CAD patients. American College of Cardiology.
National Cancer Institute. (n.d.). Platelet.
Norgard, N. B., et al. (2009). Comparison of prasugrel and clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Vascular Health and Risk Management.
Pashek, R. E., et al. (2023). Alcohol intake including wine drinking is associated with decreased platelet reactivity in a large population sample. International Journal of Epidemiology.
Qiu, J., et al. (2017). Assessing bleeding risk in patients taking anticoagulants. American Family Physician.
Stanley, M., et al. (2023). Thrombotic thrombocytopenic purpura. StatPearls.
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