title: The Rationale for and Clinical Pharmacology of Prasugrel 5 mg.
abstract: Prasugrel is a third-generation thienopyridine platelet P2Y12adenosine 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.
authors.affiliation: Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, 46285, USA. jayacjay@aol.com.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Jakubowski
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
authors.affiliation: Department of Cardiology, Attikon University Hospital, National and Capodistrian University of Athens Medical School, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.affiliation: Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, 46285, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Small
authors.affiliation: Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, 46285, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Winters
authors.affiliation: Sinai Center for Thrombosis Research, Baltimore, MD, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gurbel
authors.affiliation: Cardiovascular Research Center at University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D058925:Receptors, Purinergic P2Y12 / Q000187:drug effects*
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D000068799:Prasugrel Hydrochloride