Aceclofenac + Paracetamol
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Drug reference
Prasugrel
Thienopyridine P2Y12 ADP-receptor inhibitor (irreversible) · Antithrombotic
START
60 mg load + aspirin, then 10 mg daily (5 mg/day if <60 kg or ≥75 y)
TYPICAL MAX
10 mg/day maintenance
STOP IF
Active major bleeding, stroke/TIA, urgent CABG (hold ≥7 days)
WATCH
Bleeding signs, Hb, weight/age dosing, do not stop prematurely after stenting
CDSCO approvedSchedule HATC B01AC22
KDIGO 2024 + manufacturer label
- ONSET
- 30min · platelet inhibition
- PEAK
- 30min · active metabolite Cmax
- t½
- 7h · active metabolite t½
- DURATION
- 1.3w · irreversible effect (platelet lifespan)
EXCRETION
~68% renal, ~27% faecal metabolites
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Use only if clearly needed — limited data; bleeding risk peripartum
FDA category + note
Top interactionssee all 12 →
- Aceclofenac + ParacetamolSevereTextbookG&G 14e
- AceclofenacSevereTextbookG&G 14e
- CapsaicinSevereTextbookG&G 14e
- DapoxetineSevereTextbookG&G 14e
Available in India
47 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Prodrug rapidly hydrolysed then CYP-activated to a thiol metabolite that irreversibly binds platelet P2Y12 receptors, blocking ADP-mediated platelet activation/aggregation; faster and more consistent platelet inhibition than clopidogrel.
Indications
Acute coronary syndrome managed with PCI (with aspirin)
Dosing
- Adult
- 60 mg PO loading dose, then 10 mg once daily with aspirin; consider 5 mg/day if <60 kg or ≥75 years.
- Pediatric
- Sickle-cell (studied) not standard; not for routine paediatric use.
- Renal adjustment
- No dose adjustment (limited ESRD experience).
- Hepatic adjustment
- Mild–moderate: no adjustment. Severe (Child-Pugh C): contraindicated.
- Geriatric
- ≥75 years: generally avoid; if used, 5 mg/day (higher bleeding/uncertain benefit).
- Max dose
- 60 mg load; 10 mg/day maintenance
Pharmacokinetics
Onset
Platelet inhibition within ~30 min of load
Peak effect
Active metabolite Cmax ~0.5 h
Duration
~7–10 days (irreversible — platelet lifespan)
Half-life
Active metabolite ~7 h
Bioavailability
>79% absorbed
Protein binding
~98% (active metabolite)
Metabolism
Esterase hydrolysis then CYP3A4/2B6 (CYP2C19/2C9 minor) activation
Excretion
~68% renal, ~27% faecal (metabolites)
Contraindications
- Active pathological bleeding
- Prior stroke or transient ischaemic attack
- Hypersensitivity to prasugrel
- Severe hepatic impairment (Child-Pugh C)
Side effects
Common
Bleeding (minor)Bruising/epistaxisAnaemiaHypertension
Serious
- Major/fatal bleeding (GI, intracranial)
- Thrombotic thrombocytopenic purpura (rare)
- Severe hypersensitivity/angioedema
- Stent thrombosis if discontinued prematurely
Pregnancy & lactation
Pregnancy
Use only if clearly needed — limited data; bleeding risk peripartum
Lactation
Unknown; avoid
Drug interactions
Aceclofenac
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Capsaicin
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Dapoxetine
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Diclofenac + Paracetamol
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Escitalopram + Clonazepam
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Etoricoxib
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Ibuprofen + Paracetamol
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Paracetamol + Caffeine + Phenylephrine
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Paracetamol
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Tenoxicam
Severe
Textbook
Increased bleeding risk.
Exercise caution and monitor for signs of bleeding.
Source: G&G 14e
Abciximab
Severe
Database
.
Source: DDInter
Related guidelines
Ask House about Prasugrel
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19