Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes

Prasugrel (Efient, Eli Lilly and Company/Daiichi-Sankyo) is an oral inhibitor of platelet activation and aggregation. It works by the irreversible binding of its active metabolite to the P2Y12 class of adenosine diphosphate receptors on platelets. It has a marketing authorisation when co-administered with aspirin for the prevention of atherothrombotic events in adults with acute coronary syndrome (that is, unstable angina or non-ST-segment-elevation myocardial infarction [NSTEMI] or ST-segment-elevation myocardial infarction [STEMI]) undergoing primary or delayed percutaneous coronary intervention.

The summary of product characteristics for prasugrel states that it should be started with a single 60 mg loading dose and then continued at 10 mg once a day. People taking prasugrel should also take 75 mg to 325 mg aspirin daily. Treatment for up to 12 months is recommended unless stopping prasugrel is clinically indicated.

According to the summary of product characteristics, the use of prasugrel in people 75 years or older is generally not recommended. However, if treatment is deemed necessary a reduced maintenance dose of 5 mg should be prescribed. For people who weigh less than 60 kg, the summary of product characteristics states that the 10 mg maintenance dose is not recommended and the 5 mg maintenance dose should be used. For people with unstable angina or NSTEMI, if coronary angiography is performed within 48 hours after admission, the summary of product characteristics states that the loading dose should only be given at the time of percutaneous coronary intervention.

The summary of product characteristics lists the following adverse reactions for prasugrel: increased bleeding risk, hypersensitivity reactions including angioedema, and thrombotic thrombocytopenic purpura. For full details of adverse reactions and contraindications, see the summary of product characteristics.

The price of prasugrel is £47.56 per 28-tab pack (excluding VAT, BNF edition 67). The cost of treatment for 12 months is £628.47 (excluding VAT). Costs may vary in different settings because of negotiated procurement discounts.