Names and pronunciation
(kan′grel-or) Kengreal
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Drug reference
(kan′grel-or) Kengreal
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Func. class.: Platelet aggregation inhibitor
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Chem. class.: ADP receptor antagonist
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ACTION: A direct competitive inhibi- tor of a platelet receptor, prevents further signaling and platelet activation, results in inhibition of platelet activation and aggregation, does not require hepatic conversion to an active metabolite
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USES: For use as an adjunct to percu- taneous coronary intervention (PCI) for myocardial infarction prophylaxis, repeat coronary revascularization, and stent thrombosis in patients who have not been treated with a P2Y12 platelet inhibi- tor and are not being given a glycopro- tein IIb/IIIa inhibitor
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CONTRAINDICATIONS: Hyper- sensitivity, active bleeding Precautions: Pregnancy, breastfeeding, children, increased bleeding risk, neu- tropenia, agranulocytosis, renal disease
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SIDE EFFECTS CNS: Intracranial bleeding GI: GI bleeding GU: Hematuria HEMA: Bleeding RESP: Wheezing, dyspnea, broncho- spasm SYST: Anaphylaxis, angioedema
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INTERACTIONS Do not give clopidogrel or prasugrel until infusion is discontinued Increase: effect of warfarin, platelet inhibitors
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DOSAGE AND ROUTES Adjunct to PCI • Adult: IV BOLUS 30 mcg/kg as a single dose, then follow immediately by 4 mcg/ kg/min continuous IV infusion; the bolus should be given before PCI and mainte- nance infusion should be continued for ≥2 hr or for the duration of PCI, which- ever is longer; use ticagrelor, prasugrel, or clopidogrel to maintain platelet inhibition
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Available forms: Lyophilized powder for injection 50 mg
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Administer: • Visually inspect parenteral products for particulate matter and discoloration before use, use IV only • Reconstitution: Reconstitute by adding 5 mL sterile water for injection to a 50-mg vial, swirl until dissolved, do not shake, allow foam to settle, solution should be clear and colorless to pale yellow; with- draw contents of reconstituted 50-mg vial and add to 250-mL bag of 0.9% sodium chloride injection or dextrose 5% injec- tion resulting in a final infusion concen- tration of 200 mcg/mL; usually, 1 bag should be sufficient for most patients for ≥2 hr of dosing; those weighing >100 kg will require a minimum of 2 bags • Use diluted product immediately. When stored at room temperature, diluted prod- uct stable for ≤12 hr in dextrose 5% injec- tion and 24 hr in 0.9% sodium chloride injection, use a dedicated line • Bolus injection should be adminis- tered rapidly (<1 min). The bolus vol- ume may be withdrawn from the diluted infusion bag and given by IV push or us- ing an infusion pump • Ensure the bolus dose is completely administered prior to start of PCI • Start the continuous IV infusion imme- diately after administration of the bolus; use infusion pump for the continuous IV infusion
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Assess: • Bleeding: intracranial, retroperito- neal, other frank bleeding, after comple- tion of infusion, platelet inhibition de- creases rapidly within 1 hr; monitor Hct/ HB • Hypersensitivity: identify if patient has a known cangrelor hypersensitivity • Severe renal impairment: decreased renal function may occur in severe renal impairment, CCr >30 mL/min; no dosage change is required • Pregnancy/breastfeeding: identify whether the patient is pregnant or breast- feeding; it is not known whether product is excreted in breast milk, no well-con- trolled studies
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Evaluate: • Therapeutic response: platelet inhibi- tion during PCI
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Use and expected results • Pregnancy/breastfeeding: to inform prescriber if pregnancy is planned or suspected, or if breastfeeding • Bleeding: to report bleeding imme- diately (blood in stools, urine, gums, bruising) • Hypersensitivity: to report immedi- ately any difficulty breathing; hives; swelling of face, lips, mouth
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PHARMACOKINETICS Half-life 3-6 min; plasma protein binding 97%; effect on platelets 2 min, excreted in urine
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• Adult: IV BOLUS 30 mcg/kg as a single dose, then follow immediately by 4 mcg/ kg/min continuous IV infusion; the bolus should be given before PCI and mainte- nance infusion should be continued for ≥2 hr or for the duration of PCI, which- ever is longer; use ticagrelor, prasugrel, or clopidogrel to maintain platelet inhibition
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