Prasugrel

Prasugrel may cause serious or life-threatening bleeding. Tell your doctor if you currently have or have had a condition that causes you to bleed more easily than normal, if you have recently had surgery or been injured in any way, or if you have or have ever had a stomach ulcer; bleeding in your stomach, intestines, or head; a stroke or mini-stroke; a condition that may cause bleeding in your intestines such as polyps (abnormal growths in the lining of the large intestine) or diverticulitis (inflamed bulges in the lining of the large intestine); or liver disease. Tell your doctor and pharmacist if you are taking medications that may cause bleeding including anticoagulants (blood thinners) such as warfarin (Coumadin, Jantoven); heparin; other medications to treat or prevent blood clots; or regular use of a nonsteroidal anti-inflammatory medications such as ibuprofen (Advil, Motrin), and naproxen (Aleve). Your doctor may not prescribe prasugrel for you if you have any of these conditions, you are taking any of these medications, you weigh less than 132 lb (60 kg), or you are older than 75 years of age. Your doctor also will probably not prescribe prasugrel if you are likely to need heart bypass surgery (a certain type of open heart surgery) right away. While you are taking prasugrel, you will probably bruise and bleed more easily than usual, bleed for longer than usual, and have nosebleeds. However, if you experience any of the following symptoms, call your doctor immediately: bleeding that is unexplained, severe, long-lasting, or uncontrollable; pink or brown urine; red or black, tarry stools; vomit that is bloody or that looks like coffee grounds; coughing up blood or blood clots; or bruises that are unexplained or that get larger.

If you are having surgery, including dental surgery, or any type of medical procedure, tell your doctor or dentist that you are taking prasugrel. Your doctor will probably tell you to stop taking prasugrel at least 7 days before your surgery is scheduled.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with prasugrel and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) to obtain the Medication Guide.

Talk to your doctor about the risk of taking prasugrel.

Prasugrel is used along with aspirin to prevent serious or life-threatening problems with the heart and blood vessels in people who have had a heart attack or severe chest pain and have been treated with angioplasty (procedure to open the blood vessels that supply blood to the heart). Prasugrel is in a class of medications called anti-platelet medications. It works by preventing platelets (a type of blood cell) from collecting and forming clots that may cause a heart attack or stroke.

Prasugrel comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take prasugrel at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take prasugrel exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the tablet whole; do not split, break, chew, or crush it.

Prasugrel will help prevent serious problems with your heart and blood vessels only as long as you take the medication. Do not stop taking prasugrel without talking to your doctor. If you stop taking prasugrel, there is a higher risk that you may have a heart attack, develop a blood clot, or die.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking prasugrel,

• tell your doctor and pharmacist if you are allergic to prasugrel, clopidogrel (Plavix), ticlopidine (Ticlid), any other medications, or any of the ingredients in prasugrel tablets. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking prasugrel. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• the following nonprescription products may interact with prasugrel: nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve). Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking prasugrel. Do not start any of these medications while taking prasugrel without discussing with your healthcare provider.
• tell your doctor if you have or have ever had kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking prasugrel, call your doctor.
• talk to your doctor about the risks and benefits of taking prasugrel if you are 75 years of age or older.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Prasugrel may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness
• excessive tiredness
• pain in the back, arms, or legs
• cough

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• fever
• weakness
• paleness
• purple patches on the skin
• yellowing of the skin or eyes
• shortness of breath
• slow, fast, or irregular heartbeat
• headache
• confusion
• seizures
• slow or difficult speech
• sudden weakness of an arm or leg
• stomach pain
• nausea
• vomiting
• diarrhea
• decreased urination
• rash
• swelling of the eyes, face, mouth, lips, tongue, throat, arms, hands, feet, ankles, or lower legs

Prasugrel may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. The medication will come with a gray cylinder that helps keep the tablets dry; leave this cylinder in the container with the medication. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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