Prasugrel - Amber Drug Guidance for the treatment of patients with intracranial stents

Publication: 18/10/2018  
Next review: 18/10/2023  
Clinical Guideline
ID: 5751 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Prasugrel: Amber Drug Guidance for the treatment of patients with intracranial stents


Amber Drug Level 2

Amber Level 2: Medicines initiated by a specialist where there is not a need for ongoing monitoring other than for general adverse effects (as listed in the BNF and SPC).  These medicines are considered suitable for GP prescribing (which may include titration of dose) following specialist initiation and assessment of efficacy.  All patients on Amber Level 2 drugs should still be regularly reviewed in primary care regarding their Amber Drug treatment.   A brief prescribing guidance document will be available for these drugs, but there is no requirement for full Amber Drug Guidance. 

We have started your patient on Prasugrel as anti-platelet agent after placement of intracranial stent for aneurysm treatment. We will continue to see the patient and prescribe Prasugrel until the patient (and their condition) is stable (minimum period of 2 weeks). After this period the GP will be asked to take over prescribing and disease monitoring for an additional 6 months. No additional monitoring specific to the drug to be undertaken by the GP.

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Prescribing Information

Drug:                          Prasugrel

Indication:                 To prevent clot formation and stroke in patients where we have implanted an intracranial stent for aneurysm treatment. Please note that this is a licensed drug used for an unlicensed indication.

Classification:           Amber Level 2

Monitoring:               Routine disease monitoring should continue. No additional monitoring specific to the drug to be undertaken by the GP. Catheter cerebral angiography and MRI imaging will be organised by the treating neuroradiologist or neurosurgeon.

Follow up:                 Review in clinic at 6 weeks, interval imaging (usually at 6 months and 2 years with MRI). Some patients will also require formal catheter angiography. There will be direct communication of results and implications to patient and GP.
                                   In addition, all patient have the contact details of our clinical nurse specialist to discuss any issues.


The following is a summary of prescribing information only.  Consult the BNF and SPC for full and current prescribing information.  Link to Leeds formulary.

The following information has been added only if it differs from the BNF and SPC or supports that information.

Dose: 5mg once daily

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Contact Names and Details

Leeds Teaching Hospitals NHS Trust

Medicines Information phone number and e-mail: 0113 2064344

Medicines Information Patient Helpline phone number: 0113 2064376

Specialist who makes request via switchboard:        

LGI:     0113 2432799
SJUH:  0113 2433144


Declarations of Interest

Declarations of Interest by authors

All (or any) declarations of interest were declared and considered, through the appropriate process.

Contributors are to declare any changes to their declaration of interest submission within 28 days.

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Responsibilities of the Specialist

Secondary care clinician responsibilities:

  • Diagnosis of condition and ensuring other treatment options have been fully explored
  • Liaison with the General Practitioner (GP) to initiate prescribing of the amber medicine using a written request
  • Advising GP on initiation
  • Outlining to the GP when therapy may be stopped assuming no relapse in patient’s condition - 6 month course
  • Responding to issues raised by GP

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Responsibilities of GP

GP responsibilities:

  • Checking for allergies, interactions and contra-indications on initiation and when changing treatment
  • Prescribing the amber medicine after receiving request from secondary care clinician
  • Monitoring the patient’s overall health and wellbeing, observing patient for evidence of ADRs and liaising with secondary care clinician if necessary.  Routine disease monitoring should continue
  • Ensuring advice is sought from the secondary care clinician if there is any significant change in the patient’s physical health status that may affect prescribing or appropriateness of the amber medicine
  • Reducing/stopping treatment in line with secondary care clinician’s original request

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Responsibilities of Patient/Carer

Patient/carer responsibilities:

  • To be responsible for taking this medication as prescribed
  • To understand the potential for adverse events and report these to the GP 
  • To check with the community pharmacist that there are no interactions with this medication, when buying any over the counter medicines or herbal/homoeopathic products 
  • To check with dentists or other specialists who may prescribe medicines that there are no interactions with this medication 
  • To contact the GP, Specialist or Medicines Information patient helpline if further information or advice is needed about this medication 


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Record: 5751
Clinical condition:
Target patient group:
Target professional group(s): Pharmacists
Adapted from:

Evidence base

Not supplied

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied