Use of Prasugrel in a Patient with Clopidogrel Hypersensitivity

Peppard, Sarah; Held-Godgluck, Bethanne M.; Beddingfield, Richard H

doi:10.1345/aph.1q287

Cited by 15 publications

(6 citation statements)

References 26 publications

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“…Because of study size and design (testing vs. oral challenge) this rate should be interpreted with caution. There are two case reports discussing the safe use of prasugrel in patients with a history of hypersensitivity to clopidogrel and include patients with a history of Stevens-Johnson syndrome and angioedema reactions [47,48]. Another case report also described a patient with generalized pruritic maculopapular rash caused by prasugrel to be successfully desensitized using a 7-h protocol [49].…”

Section: Cross-reactivitymentioning

confidence: 99%

Management Strategies for Clopidogrel Hypersensitivity

Beavers

Carris

Ruf

2015

Drugs

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Clopidogrel is a cornerstone of dual antiplatelet therapy. Hypersensitivity reactions potentially limit the use of this treatment and present a significant clinical challenge. The authors have developed recommendations for the management of clopidogrel hypersensitivity with consideration for the etiology, pathophysiology, and critical evaluation of potential management strategies. The clopidogrel hypersensitivity reaction is complex in mechanism and presents generally around day 5 of treatment. Generalized reactions are most common, but the reaction may also be localized or systemic. Screening patients for hypersensitivity is not always possible because the type IV delayed reaction is not detected reliably by conventional skin prick, intradermal challenge, or patch testing. Proposed strategies for management of clopidogrel hypersensitivity include treatment of the reaction with corticosteroids, clopidogrel desensitization, substituting an alternative P2Y12 inhibitor, or clopidogrel avoidance. The safety, efficacy, and cost of each potential strategy must be considered when managing a patient with clopidogrel hypersensitivity.

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Section: Cross-reactivitymentioning

confidence: 99%

Management Strategies for Clopidogrel Hypersensitivity

Beavers

Carris

Ruf

2015

Drugs

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“…Successful use of prasugrel in a patient with a serious allergy to clopidogrel has been reported. 7 However, to our knowledge, this is the first case report of clopidogrel being successfully used in a patient with allergy to prasugrel.…”

mentioning

confidence: 79%

Prasugrel-Induced Rash

et al. 2012

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sleep (tolerance developed to these effects by day 3 of continuous exposure). 6 It has even been reported that codeine produced a clinical improvement in individuals with narcolepsy. 7 Hence, morphine (contrary to its name) and perhaps other opioids might not induce dreams but might actually inhibit them.Negative effects on sleep have potentially important clinical implications. A cycle can be established: pain prompts treatment with opioids and also negatively impacts sleep (increasing wakefulness and decreasing REM stage sleep) 8,9 ; sleep loss and REM sleep loss are hyperalgesic 10 ; therefore, pain-induced (REM) sleep loss leads to hyperalgesia, which leads to greater demand for opioids, which leads to more (REM) sleep loss, and other consequences. One might speculate that such a cycle could contribute to opioid tolerance or even to the phenomenon of opioid-induced hyperalgesia.After over 100 years, it might be that the best-known drug naming in medicine (morphine) is also the biggest misnomer.

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“…9 The extent of cross-reactivity between clopidogrel and prasugrel is uncertain, because conflicting cases have been reported. [10][11][12] Peppard et al 11 and Felix-Getzik and Sylvia 10 described cases in which patients with clopidogrel hypersensitivity were successfully transitioned to prasugrel without cross-reactivity. 10,11 Conversely, Raccah et al 12 published a case in which a patient developed a similar maculopapular rash when rechallenged with prasugrel following clopidogrel hypersensitivity.…”

Section: Discussionmentioning

confidence: 99%