cangrelor (Rx)

Brand and Other Names:Kengreal
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Dosing & Uses

AdultPediatric

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

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Interactions

Interaction Checker

and cangrelor

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (2)

              • 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.

              • caplacizumab

                caplacizumab, cangrelor. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • 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.

              Minor (0)

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                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

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                Warnings

                Contraindications

                Significant active bleeding

                Hypersensitivity

                Cautions

                Increased risk of bleeding; bleeding events of all severities were more common with cangrelor than with clopidogrel

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                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.

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                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

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                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

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Kengreal intravenous
                -
                50 mg vial
                Kengreal intravenous
                -
                50 mg vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                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) 2021 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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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

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                Adding plans allows you to:

                • View the formulary and any restrictions for each plan.
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                • Compare formulary status to other drugs in the same class.
                • Access your plan list on any device – mobile or desktop.

                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.