[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Antiplatelet drugs](https://durgical.com/en/pharmacology/classes/antiplatelet-drugs/) › Prasugrel [Pharmacology](https://durgical.com/en/pharmacology/) · [Antiplatelet drugs](https://durgical.com/en/pharmacology/classes/antiplatelet-drugs/) # Prasugrel An oral thienopyridine that blocks P2Y12 irreversibly, more strongly than clopidogrel. Not used after a stroke or transient ischaemic attack. Updated 2026-11-01 - Class: [Antiplatelet drugs](https://durgical.com/en/pharmacology/classes/antiplatelet-drugs/) - Receptor: P2Y12 ADP receptor on platelets - ATC code: B01AC22 ◎**P2Y12 ADP receptor on platelets**Prasugrel ⓘ The figure shows the human P2Y12 receptor with AZD1283, an experimental P2Y12 blocker. Prasugrel's active metabolite binds covalently and has no structure with the receptor. **Target in 3D:** P2Y12 ADP receptor on platelets. PDB structure 4NTJ (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/4NTJ) · Drag to rotate · pinch to zoom ## Mechanism of action Prasugrel is a prodrug. In the gut it is quickly hydrolysed to a thiolactone, which liver enzymes (mainly CYP3A4 and CYP2B6) turn into the active metabolite in a single step. The metabolite binds P2Y12 irreversibly, blocking ADP-driven activation and aggregation for the rest of the platelet's life. Because its activation is simpler, common CYP2C19 variants do not change its effect. - Gut esterases turn prasugrel into a thiolactone - One liver step (CYP3A4, CYP2B6) makes the active metabolite - It binds P2Y12 irreversibly: platelets blocked for life ## Pharmacokinetics **Absorption** Rapid; prasugrel itself is not detected in plasma. **Distribution** The active metabolite is about 98% bound to albumin. **Metabolism** Intestinal hydrolysis, then one step mainly by CYP3A4 and CYP2B6; CYP2C19 genotype has no relevant effect. **Half-life** About 7 hours for the active metabolite (range 2 to 15). **Onset and duration** About 90% of patients reach at least 50% platelet inhibition within 1 hour of a loading dose. ## Indications - Acute coronary syndrome (unstable angina, NSTEMI or STEMI) managed with percutaneous coronary intervention, together with aspirin. [Myocardial Infarction (Heart Attack) →](https://durgical.com/en/conditions/myocardial-infarction/) ## Adverse effects ### Common - Bleeding, including nosebleeds and bruising - Anaemia - Headache, dizziness, back pain ### Serious (rare, important) - Significant, sometimes fatal bleeding - Bleeding related to coronary bypass surgery - Thrombotic thrombocytopenic purpura (TTP) - Allergic reactions, including angioedema ## Contraindications - Active pathological bleeding - Prior transient ischaemic attack or stroke - Hypersensitivity to prasugrel ## Key interactions **Warfarin, NSAIDs and other drugs that raise bleeding risk** Increase the risk of bleeding. **Opioids such as morphine** Can delay and reduce platelet inhibition after the loading dose. ## What is monitored - Signs of bleeding, especially after invasive procedures (suspect it with low blood pressure) - Haemoglobin - Platelet count and smear if TTP is suspected ## Administration and safety - Oral, with or without food, together with aspirin - Generally not recommended from age 75, except in high-risk patients (diabetes or prior MI); low body weight increases exposure - Not started when urgent coronary bypass surgery is likely; stopped several days before surgery when possible, as planned by the team - Not stopped early without the cardiology team ## Nursing care - Ask about previous stroke or transient ischaemic attack before the first dose: it is a contraindication - Note age and body weight, which change bleeding risk - Watch for bleeding and low blood pressure after catheterisation - Teach the patient to tell every dentist and surgeon and to report purple spots, fever or confusion ## Pregnancy and breastfeeding There are no human data in pregnancy; animal studies showed no malformations. Bleeding at delivery is a concern. ## Memory aid PRASugrel = PRoblem After Stroke: strong and irreversible, but not after stroke or TIA, and careful in the old and the light. ## Test yourself Think of the answer, then tap the question to see it. ## Why does CYP2C19 genotype matter for clopidogrel but not for prasugrel? Prasugrel becomes active through intestinal hydrolysis and one liver step, mainly CYP3A4 and CYP2B6; CYP2C19 variants have no relevant effect on its active metabolite. ## Which history contraindicates prasugrel? A previous stroke or transient ischaemic attack, because of the higher risk of intracranial bleeding. ## In which patients is prasugrel generally not recommended because of bleeding? People aged 75 or more (except high-risk cases such as diabetes or prior MI); low body weight also raises exposure and bleeding risk. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/prasugrel/) ## Related drugs - [Clopidogrel](https://durgical.com/en/pharmacology/clopidogrel/) - [Ticagrelor](https://durgical.com/en/pharmacology/ticagrelor/) - [Acetylsalicylic acid](https://durgical.com/en/pharmacology/acetylsalicylic-acid/) ## Related conditions - [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/) [← Back to the class: Antiplatelet drugs](https://durgical.com/en/pharmacology/classes/antiplatelet-drugs/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - PRASUGREL tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f51e64e0-f556-65d0-a876-fb709aaeefea) (DailyMed (U.S. National Library of Medicine), 2026); [Prasugrel: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a609027.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [4NTJ: Structure of the human P2Y12 receptor in complex with an antithrombotic drug](https://www.rcsb.org/structure/4NTJ) (RCSB Protein Data Bank, 2014). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/prasugrel/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/prasugrel/