prasugrel-hydrochloride and Drug-Hypersensitivity

Allergic reactions to clopidogrel soon after coronary stent implantation pose an important and challenging clinical problem. We describe a 44-year-old man who developed a diffuse maculopapular rash four days after initiation of clopidogrel with drug-eluting coronary stent placement. An initial treat-through strategy was unsuccessful due to patient intolerance to corticosteroids. Because of persistent hypersensitivity, clopidogrel was substituted with prasugrel which was continued successfully for one year without reaction. A systematic review of the literature was performed which identified 10 prior case reports of patients with clopidogrel hypersensitivity who were subsequently treated with prasugrel. Patient characteristics and clinical outcomes of these patients plus the current case were reviewed. There were 9 men and 2 women with ages from 44 to 76 years. All patients had undergone coronary stent procedures. Prasugrel was successfully used without cross-reactivity in 9 of the 11 patients (82%). Cross-reactivity was reported in two patients who developed hypersensitivity reactions to prasugrel similar to those experienced on clopidogrel. In conclusion, prasugrel can be used successfully in most patients with a history of clopidogrel hypersensitivity. However, potential cross-reactivity between these two thienopyridines may occur in some patients.

Topics: Adult; Clopidogrel; Coronary Artery Disease; Drug Hypersensitivity; Drug Substitution; Drug-Eluting Stents; Humans; Male; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Ticlopidine

Topics: Aged; Aspirin; Desensitization, Immunologic; Drug Administration Schedule; Drug Eruptions; Drug Hypersensitivity; Drug Therapy, Combination; Drug-Eluting Stents; Everolimus; Humans; Immunosuppressive Agents; Male; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; ST Elevation Myocardial Infarction

Topics: Adenosine; Aspirin; Clopidogrel; Coronary Vessels; Drug Hypersensitivity; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Recurrence; Stents; Thrombosis; Ticagrelor; Ticlopidine

Topics: Aspirin; Clopidogrel; Coronary Disease; Cost Savings; Desensitization, Immunologic; Drug Hypersensitivity; Drug Substitution; Humans; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists; Salicylates; Ticlopidine

A case illustrating multiple considerations in choosing safe and effective dual antiplatelet therapy for a patient with a history of clopidogrel allergy-including concerns relating to a national drug shortage-is described.. A 75-year-old woman required dual antiplatelet therapy (aspirin plus a thienopyridine) after a cardiac catheterization procedure; during a prior emergency department visit for acute coronary syndrome, she had experienced an allergic reaction within 24 hours of receiving dual therapy including clopidogrel. A team of pharmacy and allergy staff determined that challenging the patient with prasugrel was the best treatment option. Key considerations in the decision-making process included (1) concerns that an alternative thienopyridine, ticlopidine, might be unavailable for long-term outpatient use due to an ongoing national drug shortage, (2) the patient's concomitant use of metoprolol (cessation of β-blocker use is recommended for four days before attempted clopidogrel desensitization), and (3) recent reports of the safe use of prasugrel in three patients with a history of clopidogrel allergy. In the case described here, prasugrel administration was effective and did not result in adverse effects; however, the risk of cross-reactivity of clopidogrel and ticlopidine or prasugrel remains largely unknown. The case highlights the importance of careful consideration of a number of patient- and drug-specific factors in the selection of the most appropriate antiplatelet dual therapy for patients with a history of allergic reactions to clopidogrel.. A shortage of ticlopidine prompted the use of prasugrel in a clopidogrel-allergic patient requiring dual antiplatelet therapy. Prasugrel therapy was well tolerated, with no evidence of allergic reaction.

Topics: Aged; Clopidogrel; Drug Hypersensitivity; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Piperazines; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Thiophenes; Ticlopidine

Topics: Atherectomy, Coronary; Blood Vessel Prosthesis Implantation; Clopidogrel; Coronary Artery Disease; Desensitization, Immunologic; Drug Dosage Calculations; Drug Hypersensitivity; Humans; Male; Middle Aged; Piperazines; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists; Referral and Consultation; Stents; Thiophenes; Ticlopidine

Topics: Adult; Clopidogrel; Coronary Artery Disease; Drug Hypersensitivity; Female; Fever; Humans; Piperazines; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Thiophenes; Ticlopidine

We report a case with a hypersensitivity reaction to clopidogrel that resolved after clopidogrel discontinuation and recurred on rechallenge. The reaction included fever, tachycardia, rash and mild angioedema. As an alternative to clopidogrel, the more potent thienopyridine prasugrel was administered without any signs of an allergic reaction in the hours, days and weeks following administration.

Topics: Aged; Angioedema; Clopidogrel; Drug Hypersensitivity; Exanthema; Fever; Humans; Male; Piperazines; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists; Tachycardia; Thiophenes; Thrombosis; Ticlopidine

To report a case of successful use of prasugrel following percutaneous coronary intervention with placement of a bare metal stent in a patient with a documented hypersensitivity reaction to clopidogrel.. A 61-year-old male with a history of coronary artery disease with coronary stent placement presented with ST-elevation myocardial infarction. The patient had developed Stephens-Johnson syndrome 6 years earlier following clopidogrel administration, characterized by erythematous plaques and subsequent desquamation of the hands and feet; clopidogrel was discontinued and he was subsequently treated with ticlopidine in addition to aspirin. The third-generation thienopyridine prasugrel was initiated as a therapeutic alternative to clopidogrel after placement of a bare metal stent; a 60-mg dose was administered after extubation, followed by 10 mg/day. No signs of allergic reaction were observed in the days, weeks, and months following administration.. Thienopyridines, specifically clopidogrel, are the standard of care for prevention of coronary stent thrombosis; however, there are few data available on cross-hypersensitivity between these agents. One study demonstrated that 27% of patients who developed an allergic or hematologic reaction to clopidogrel developed a similar reaction to ticlopidine. Other therapeutic options for patients with clopidogrel hypersensitivity who are undergoing a percutaneous coronary intervention with stent placement include clopidogrel desensitization, warfarin plus aspirin, cilostazol, ticagrelor, and ticlopidine. However, these options are limited by efficacy and/or toxicity. With its approval in 2009, prasugrel has become a potential treatment option.. Prasugrel may be considered a therapeutic alternative in some patients allergic or intolerant to clopidogrel, but additional data are warranted to make a strong conclusion.

Topics: Angioplasty, Balloon, Coronary; Clopidogrel; Drug Hypersensitivity; Humans; Male; Middle Aged; Myocardial Infarction; Piperazines; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists; Stents; Thiophenes; Thrombosis; Ticlopidine; Treatment Outcome

Topics: Clopidogrel; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Male; Middle Aged; Piperazines; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Thiophenes; Ticlopidine