Drug General Information (ID: DDIZNFMKP6)
Drug Name			Meperidine		Drug Info		Prasugrel		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anesthetics				Antiplatelet Agents
Structure

Mechanism of Meperidine-Prasugrel Interaction (Severity Level: Moderate)
Altered gastrointestinal dynamics Click to Show/Hide Mechanism Graph
Drug Name		Meperidine				Prasugrel
Mechanism		Delayed gastric emptying				Absorption affected by delayed gastric emptying
Key Mechanism Factor 1
		Factor Name		Gastrointestinal Motility
		Factor Description		Gastrointestinal motility is an important factor in determining the absorption of orally administered drugs, and it controls the residence time of the drug in the digestive tract.
Mechanism Description		Altered absorption of Prasugrel due to GI dynamics variation caused by Meperidine

Recommended Action
Management		Although data are limited, caution is recommended when orally administered P2Y12 inhibitors are given concomitantly with opioid agonists. In acute coronary syndrome patients who require an opioid agonist, the use of a parenteral antiplatelet agent, such as cangrelor, should be considered.

References
1	Agencia Espaola de Medicamentos y Productos Sanitarios Healthcare "Centro de informacion online de medicamentos de la AEMPS - CIMA.".
2	Cerner Multum, Inc. "Australian Product Information.".
3	Cerner Multum, Inc. "Canadian Product Information.".
4	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
5	Hobl EL, Reiter B, Schoergenhofer C, et al. "Morphine Decreases Ticagrelor Concentrations but not its Antiplatelet Effects: A Randomized Trial in Healthy Volunteers." Eur J Clin Invest 46 (2015): 7-14. [PMID: 26449338]
6	Hobl EL, Reiter B, Schoergenhofer C, et al. "Morphine interaction with prasugrel: a double-blind, cross-over trial in healthy volunteers." Clin Res Cardiol 105 (2015): 349-55. [PMID: 26493304]
7	Hobl EL, Stimpfl T, Ebner J, et al. "Morphine Decreases Clopidogrel Concentrations and Effects: A Randomized, Double Blind, Placebo-Controlled Trial." J Am Coll Cardiol (2013):. [PMID: 24315907]
8	Kubica J, Adamski P, Ostrowska M, et al. "Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial." Eur Heart J (2015):. [PMID: 26491112]
9	Kubica J, Kubica A, Jilma B, et al. "Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors." Int J Cardiol 215 (2016): 201-208. [PMID: 27128531]
10	Product Information. Brilinta (ticagrelor). Astra-Zeneca Pharmaceuticals, Wilmington, DE.
11	Product Information. Effient (prasugrel). Lilly, Eli and Company, Indianapolis, IN.
12	Product Information. Plavix (clopidogrel). Bristol-Myers Squibb, Princeton, NJ.