cangrelor

REMS

Adjunct to percutaneous coronary intervention (PCI) in patients not currently receiving a P2Y₁₂ platelet inhibitor and are not receiving a glycoprotein IIb/IIIa inhibitor.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Significant severe bleeding.

Use Cautiously in:

OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

Hemat: bleeding

Resp: dyspnea

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of other P2Y12 inhibitors, including clopidogrel, prasugrel, or ticagrelor, ↑ risk of bleeding.
Blocks antiplatelet effects of concurrently administered clopidogrel or prasugrel; administer clopidogrel or prasugrel after cangrelor infusion is discontinued.

Availability ⬆ ⬇

Lyophilized powder for injection: 50 mg/vial

Route/Dosage ⬆ ⬇

IV (Adults ): 30 mcg/kg bolus prior to PCI; then 4 mcg/kg/min infusion for 2 hr or duration of procedure, whichever is longer; should be followed by initiation of an oral P2Y₁₂ platelet inhibitor.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Inhibits platelet aggregation by reversibly interacting with platelet P2Y₁₂ADP receptors, preventing signal transduction and platelet activation.

Therapeutic effects:

↓risk of periprocedural MI, repeat coronary revascularization or stent thrombosis associated with PCI.

Classifications ⬆ ⬇

Therapeutic Classification: antiplatelet agents

Pharmacologic Classification: platelet aggregation inhibitors

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Minimally distributed to tissues.

Protein Binding: 97–98%.

Metabolism/Excretion: Metabolized rapidly in the bloodstream; metabolites do not have antiplatelet activity. 58% excreted by kidneys; 35% in feces.

Half-Life: 3–6 min.

Time/Action Profile ⬆ ⬇

(antiplatelet effect)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	2 min	1 hr‡

‡Following discontinuation.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient, and explain the transition to oral antiplatelet therapy, if applicable.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Advise patient to notify health care professional if bleeding occurs.
Advise patient about hypersensitivity reactions and to seek immediate medical attention if symptoms occur.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Avoid neuraxial blockade procedures, and when possible, discontinue cangrelor 1 hr before labor, delivery, or neuraxial blockade.

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Indications ⬇