Drug Interaction Report

MONITOR CLOSELY: The combination of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors and other drugs that inhibit platelet aggregation may significantly increase the risk of bleeding, especially from arterial puncture sites. The mechanism is synergistic pharmacologic effects. However, in a phase 3 clinical trial (TRITON-TIMI 38) evaluating the safety and efficacy of prasugrel and clopidogrel in patients with acute coronary syndrome (ACS) undergoing percutaneous intervention (PCI), the use of a GP IIb/IIIa inhibitor (type used not uniformly captured in the study) did not increase the relative risk of bleeding with prasugrel as compared with clopidogrel when the thienopyridine loading dose was administered shortly before or at the time of PCI.

MANAGEMENT: Extraordinary precautions are recommended if these drugs must be used together, including monitoring platelet counts and hemoglobin concentrations. In addition, invasive procedures, such as urinary catheterization, nasogastric or nasotracheal intubation, and even venous punctures should be avoided or minimized. Non-compressible venous access sites, such as jugular or subclavian sites, should be avoided.