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American Journal of Cardiovascular Drugs

, Volume 17, Issue 2, pp 109–121 | Cite as

The Rationale for and Clinical Pharmacology of Prasugrel 5 mg

  • Joseph A. JakubowskiEmail author
  • David Erlinge
  • Dimitrios Alexopoulos
  • David S. Small
  • Kenneth J. Winters
  • Paul A. Gurbel
  • Dominick J. Angiolillo
Review Article
  • 218 Downloads

Abstract

Prasugrel is a third-generation thienopyridine platelet P2Y12 adenosine diphosphate (ADP) receptor antagonist administered with aspirin for the treatment of patients with acute coronary syndrome (ACS) with planned percutaneous coronary intervention. Prasugrel is administered periprocedurally at an oral loading dose of 60 mg followed by daily maintenance doses (MDs) of 10 mg for most patients and 5 mg for patients weighing <60 kg or aged ≥75 years. Data from a prasugrel phase III study, TRITON-TIMI 38, suggested that a lower MD might be more suitable for patients weighing <60 kg or aged ≥75 years; subsequent pharmacokinetic and pharmacodynamic studies have indicated that prasugrel 5 mg reduced platelet reactivity in these populations to an extent similar to that of prasugrel 10 mg in heavier or younger patients. Clinical experience with prasugrel 5 mg is limited, and additional studies are needed to verify the clinical efficacy and safety of this dose in these challenging populations.

Keywords

Percutaneous Coronary Intervention Acute Coronary Syndrome Clopidogrel Maintenance Dose Prasugrel 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

Appreciation is expressed to Chris Konkoy, Ph.D. of Eli Lilly and Company and Tamara Ball, MD of inVentiv Health for editorial assistance.

Compliance with Ethical Standards

Disclosures

Dr. Erlinge: Speaker honoraria: Daiichi Sankyo Company, Ltd., Eli Lilly and Company, AstraZeneca; Advisory board: AstraZeneca, Eli Lilly and Company, Merck. Dr. Alexopoulos: Speaker honoraria: AstraZeneca; Advisory Board: AstraZeneca, Boeringer Ingelheim, Bayer. Dr. Gurbel: Consultant: Daiichi Sankyo, Eli Lilly and Company, Bayer, AstraZeneca, Boehringer, Merck and Co., CSL, Janssen, and New Haven Pharmaceuticals; Grants: NIH, Daiichi Sankyo, Merck, New Haven Pharmaceuticals, Haemonetics, Sinnowa, Coramed, and Duke Clinical Research Institute; Patents: in the areas of personalized antiplatelet therapy and interventional cardiology. Dr. Angiolillo: Consulting fee or honorarium: Bayer, Amgen, Pfizer, Sanofi, Daiichi Sankyo, Inc, Eli Lilly and Company, The Medicines Company, AstraZeneca, Merck, Abbott Vascular and PLx Pharma; Review activities: CeloNova, Johnson & Johnson, and St. Jude Medical. Institution; Grants: Glaxo-Smith-Kline, Daiichi Sankyo, Inc, Eli Lilly and Company, The Medicines Company, AstraZeneca, Janssen Pharmaceuticals, Inc., Osprey Medical, Inc., Novartis, CSL Behring, and Gilead. Drs. Jakubowski, Small, and Winters are employees and minor shareholders of Eli Lilly and Company.

Funding

This review was funded by Daiichi Sankyo Company, Ltd. and Eli Lilly and Company.

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Joseph A. Jakubowski
    • 1
    Email author
  • David Erlinge
    • 2
  • Dimitrios Alexopoulos
    • 3
  • David S. Small
    • 1
  • Kenneth J. Winters
    • 1
  • Paul A. Gurbel
    • 4
  • Dominick J. Angiolillo
    • 5
  1. 1.Lilly Research LaboratoriesEli Lilly and CompanyIndianapolisUSA
  2. 2.Department of CardiologyLund UniversityLundSweden
  3. 3.Department of CardiologyAttikon University Hospital, National and Capodistrian University of Athens Medical SchoolAthensGreece
  4. 4.Sinai Center for Thrombosis ResearchBaltimoreUSA
  5. 5.Cardiovascular Research Center at University of Florida College of Medicine-JacksonvilleJacksonvilleUSA

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