Drug Interaction Report

MONITOR: Concomitant use of prasugrel with other agents that affect hemostasis including aspirin may increase the risk of bleeding. According to the product labeling, the effects of prasugrel on platelet aggregation were not significantly affected by aspirin 150 mg daily. However, bleeding time was increased compared with either drug alone. The safety of prasugrel during coadministration with other salicylates has not been established, but potentiation of gastrointestinal bleeding should be considered.

MANAGEMENT: Although prasugrel may be used with aspirin, caution is advised during coadministration with any salicylate, especially in patients at risk for gastrointestinal ulceration or bleeding. Close clinical and laboratory observation for hemorrhagic complications is recommended. Patients should be advised to contact their physician if they develop potential signs and symptoms of gastrointestinal injury such as abdominal pain, bloating, dizziness, lightheadedness, hematemesis, anorexia, and/or black, tarry stools.

GENERALLY AVOID: Use of anticholinergic agents with alcohol may result in sufficient impairment of attention so as to render driving and operating machinery more hazardous. In addition, the potential for abuse may be increased with the combination. The mechanism of interaction is not established but may involve additive depressant effects on the central nervous system. No effect of oral propantheline or atropine on blood alcohol levels was observed in healthy volunteers when administered before ingestion of a standard ethanol load. However, one study found impairment of attention in subjects given atropine 0.5 mg or glycopyrrolate 1 mg in combination with alcohol.

MANAGEMENT: Alcohol should generally be avoided during therapy with anticholinergic agents. Patients should be counseled to avoid activities requiring mental alertness until they know how these agents affect them.