Cangrelor

Cangrelor is used is used during percutaneous coronary intervention (PCI) for reducing the risk of heart attacks, repeat coronary revascularization, and stent thrombosis (ST) in patients who have not been treated with another P2Y12 platelet inhibitor and are not receiving a glycoprotein IIb/IIIa inhibitor, another class of platelet inhibitors.

Cangrelor is available under the following different brand names: Kengreal.

Dosage Forms and Strengths

Injection, Lyophilized Powder for Reconstitution

• 50 mg/vial

Dosage Considerations – Should be Given as Follows:

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 intravenous (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 hours 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 orally at any time during cangrelor infusion or immediately after discontinuation
• Prasugrel: 60 mg orally immediately after discontinuing cangrelor; do not administer prasugrel prior to cangrelor discontinuation because of drug interaction
• Clopidogrel: 600 mg orally immediately after discontinuing cangrelor; do not administer clopidogrel prior to cangrelor discontinuation because of drug interaction

Safety and efficacy not established in pediatric patients.

Common side effects of Cangrelor include:

• Bleeding
• Worsening renal function in patients with CrCl less than 30 mL/minute

Less common side effects of cangrelor include:

• Hypersensitivity

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Cangrelor has no listed severe interactions with other drugs.
• Serious interactions of cangrelor include:
  • clopidogrel
  • prasugrel
• Moderate interactions of cangrelor include:
  • acalabrutinib
  • caplacizumab
  • fish oil triglycerides
  • ibrutinib
• Cangrelor has no listed mild interactions with other drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

This medication contains cangrelor. Do not take Kengreal if you are allergic to cangrelor or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Significant active bleeding
• Hypersensitivity

Effects of Drug Abuse

• No information available.

Short-Term Effects

• See "What Are Side Effects Associated with Using Cangrelor?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Cangrelor?"

Cautions

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

Pregnancy and Lactation

Heart attack (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.

In animal reproduction studies, continuous infusion of cangrelor in pregnant rats and rabbits throughout organogenesis at dose approximately 2-times the maximum recommended human dose (MRHD) did not result in fetal malformations.

Cangrelor use during labor and delivery may increase the risk for maternal bleeding and hemorrhage. Performance of neuraxial blockade procedures is not advised during cangrelor use due to the potential risk of spinal hematoma. When possible, discontinue cangrelor 1 hour prior to labor, delivery, or neuraxial blockade.

There are no data on the presence of cangrelor in human milk or animal milk, its effects on breastfed infants, or on milk production. Due to its short-half life, cangrelor exposure is expected to be very low in breastfed infant. Consult your doctor.