Dosing & Uses
Dosage Forms & Strengths
injection, lyophilized powder for reconstitution
- 50mg/vial
Percutaneous Coronary Intervention
Indicated as an adjunct to percutaneous coronary intervention (PCI) to reduce the risk of periprocedural myocardial infarction (MI), repeat coronary revascularization, and stent thrombosis (ST) in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a glycoprotein IIb/IIIa inhibitor
30 mcg/kg IV bolus infused over 1 minute before PCI, THEN
Immediately follow bolus injection with 4 mcg/kg/min IV infusion; continue for at least 2 hr or duration of PCI, whichever is longer
Transition patients to oral P2Y12 platelet inhibitor
- Choose from 1 of the loading-dose regimens described below to initiate oral therapy:
- Ticagrelor: 180 mg PO at any time during cangrelor infusion or immediately after discontinuation
- Prasugrel: 60 mg PO immediately after discontinuing cangrelor; do not administer prasugrel prior to cangrelor discontinuation because of drug interaction
- Clopidogrel: 600 mg PO immediately after discontinuing cangrelor; do not administer clopidogrel prior to cangrelor discontinuation because of drug interaction
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- abrocitinib
abrocitinib and cangrelor both increase anticoagulation. Contraindicated. Antiplatelet drugs, except for low-dose aspirin (=81 mg qDay), during the first 3 months of treatment are contraindicated.
Serious - Use Alternative (3)
- caplacizumab
caplacizumab, cangrelor. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug.
- clopidogrel
cangrelor decreases effects of clopidogrel by receptor binding competition. Avoid or Use Alternate Drug. The expected antiplatelet effect of a 600 mg loading dose of clopidogrel was blocked when clopidogrel was administered during a cangrelor infusion. Therefore, clopidogrel should not be administered until cangrelor infusion is discontinued.
- prasugrel
cangrelor decreases effects of prasugrel by receptor binding competition. Avoid or Use Alternate Drug. The expected antiplatelet effect of a 60 mg loading dose of prasugrel was blocked when prasugrel was administered during a cangrelor infusion. Therefore, prasugrel should not be administered until cangrelor infusion is discontinued.
Monitor Closely (5)
- acalabrutinib
acalabrutinib increases effects of cangrelor by anticoagulation. Modify Therapy/Monitor Closely. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding.
- fish oil triglycerides
fish oil triglycerides will increase the level or effect of cangrelor by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.
- ibrutinib
ibrutinib will increase the level or effect of cangrelor by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.
- selumetinib
cangrelor and selumetinib both increase anticoagulation. Modify Therapy/Monitor Closely. An increased risk of bleeding may occur in patients taking a vitamin-K antagonist or an antiplatelet agent with selumetinib. Monitor for bleeding and INR or PT in patients coadministered a vitamin-K antagonist or an antiplatelet agent with selumetinib.
- warfarin
cangrelor, warfarin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Drugs with antiplatelet properties may increase anticoagulation effect of warfarin.
Minor (0)
Adverse Effects
Bleeding
GUSTO trial data
- Mild (14.9%)
- Moderate (0.4%)
- Severe/life-threatening (0.2%)
TIMI trial data
- Minor (0.6%)
- Major (0.2%)
1-10%
Worsening renal function in patients with CrCl <30 mL/min (3.2%)
<1%
Hypersensitivity
Warnings
Contraindications
Significant active bleeding
Hypersensitivity
Cautions
Drugs that inhibit platelet P2Y12 function, increase risk of bleeding
Increased risk of bleeding; bleeding events of all severities were more common with cangrelor than with clopidogrel
Bleeding complications were consistent across a variety of clinically important subgroups
Once therapy is discontinued, there is no antiplatelet effect after an hour
Pregnancy
Pregnancy
There are no available data on use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes; untreated myocardial infarction can be fatal to pregnant women and fetus
Disease-associated maternal and/or embryo/fetal risk
- Myocardial infarction is a medical emergency in pregnancy which can be fatal to pregnant woman and fetus if left untreated; life-sustaining therapy for the pregnant woman should not be withheld due to potential concerns regarding the effects of the drug on the fetus
Animal data
- In animal reproduction studies, continuous infusion of drug in pregnant rats and rabbits throughout organogenesis at dose approximately 2-times maximum recommended human dose (MRHD) did not result in fetal malformations
Labor or delivery
- Drug use during labor and delivery may increase risk for maternal bleeding and hemorrhage; performance of neuraxial blockade procedures is not advised during drug use due to potential risk of spinal hematoma; when possible, discontinue drug 1 hour prior to labor, delivery, or neuraxial blockade
Lactation
There are no data on presence of drug in human milk or animal milk, effects on breastfed infant, or on milk production; due to its short-half life, drug exposure is expected to be very low in breastfed infant
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
P2Y12 platelet inhibitor that blocks ADP-induced platelet activation and aggregation; it binds selectively and reversibly to the P2Y12 receptor to prevent further signaling and platelet activation
Absorption
Peak plasma concentration: 2 minutes
Onset of action: Within 2 minutes following 30 mcg/kg IV bolus followed by 4 mcg/kg/min IV infusion
After discontinuation of the infusion, the antiplatelet effect decreases rapidly and platelet function returns to normal within 1 hr
Distribution
Protein bound 97-98%
Vd: 3.9 L
Metabolism
Deactivated rapidly in the circulation by dephosphorylation to its primary metabolite, a nucleoside, which has negligible antiplatelet activity
Metabolism is independent of hepatic function and it does not interfere with other drugs metabolized by hepatic enzymes
Elimination
Half-life: 3-6 minutes
Excretion: 58% urine; 35% feces
Administration
IV Preparation
For each 50 mg/vial, reconstitute by adding 5 mL of sterile water for injection
Swirl gently until all material is dissolved; avoid vigorous mixing
Allow any foam to settle
Ensure that vial contents are fully dissolved and the reconstituted material is a clear, colorless to pale yellow solution
Do not use without dilution
Before administration, each reconstituted vial must be diluted further with 0.9% NaCl or D5W
Withdraw the contents from 1 reconstituted vial and add to 250-mL bag of 0.9% NaCl or D5W
Mix the bag thoroughly
This dilution results in a concentration of 200 mcg/mL and should be sufficient for at least 2 hr of dosing
Patients who weigh ≥100 kg require a minimum of 2 bags
IV Administration
Administer via a dedicated IV line
Administer the bolus volume rapidly (<1 minute), from the diluted bag via manual IV push or pump
Ensure the bolus is completely administered before the start of PCI
Start the IV infusion immediately after the bolus administration
Storage
Store at controlled room temperature (20-25°C [68-77°F]), with excursions between 15-30°C (59-86°F) permitted
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Kengreal intravenous - | 50 mg vial |  | |
| Kengreal intravenous - | 50 mg vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
cangrelor intravenous
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
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