Cangrelor parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Parenteral formulations of cangrelor.
Drugs List
Therapeutic Indications
Uses
Coronary artery disease PCI patient: reduction of thrombotic events
Cangrelor, co-administered with aspirin, is indicated for the reduction of thrombotic cardiovascular events in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) who have not received an oral P2Y12 inhibitor prior to the PCI procedure and in whom oral therapy with P2Y12 inhibitors is not feasible or desirable.
Dosage
Adults
The recommended dose of cangrelor for patients undergoing PCI is 30micrograms/kg intravenous bolus followed immediately by 4micrograms/kg/minute intravenous infusion.
The bolus and infusion should be initiated prior to the procedure and continued for at least two hours or for the duration of the procedure, whichever is longer. At the discretion of the physician, the infusion may be continued for a total duration of four hours.
Additional Dosage Information
Patients should be transitioned to oral P2Y12 therapy for chronic treatment. For transition, a loading dose of oral P2Y12 therapy (clopidogrel, ticagrelor or prasugrel) should be administered immediately following discontinuation of cangrelor infusion. Alternatively, a loading dose of ticagrelor or prasugrel, but not clopidogrel, may be administered up to 30 minutes before the end of the infusion (see specific product literature).
In patients undergoing PCI, standard procedural adjunctive therapy should be implemented.
Administration
For intravenous administration.
Contraindications
Children under 18 years
Haemorrhage
Recent surgery
Recent trauma
Risk of haemorrhage
Breastfeeding
Coagulopathy
Hereditary fructose intolerance
History of cerebrovascular accident
History of transient ischaemic attack
Impaired haemostasis
Pregnancy
Uncontrolled severe hypertension
Precautions and Warnings
Predisposition to haemorrhage
Renal impairment - creatinine clearance below 30 ml/minute
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Must be diluted before use
Treatment to be administered under the supervision of a specialist
Monitor for unexplained fall in blood pressure or haematocrit
Potential for increased risk of bleeding
Discontinue if haemorrhage occurs
Discontinue if unexplained fall in blood pressure or haematocrit occurs
Cangrelor has a half-life of 3 to 6 minutes. Platelet function is restored within 60 minutes of stopping infusion.
Pregnancy and Lactation
Pregnancy
Cangrelor is contraindicated during pregnancy.
Use of cangrelor during pregnancy is contraindicated by the manufacturer. Studies in animals have shown reproductive toxicity. There is limited data on the use of cangrelor in pregnant women. Potential risks are unknown.
Lactation
Cangrelor is contraindicated during breastfeeding.
The manufacturer makes no recommendation regarding use of cangrelor during breastfeeding. The presence of cangrelor in human breast milk is unknown. Effects on exposed infants are unknown.
Side Effects
Abnormal INR
Acute renal failure
Anaemia
Anaphylactic reaction
Anaphylactic shock
Angioedema
Cardiac tamponade
Contusion
Decrease in haemoglobin and haematocrit
Discharge (injection site)
Dyspnoea
Ear haemorrhage
Ecchymosis
Epistaxis
Gastro-intestinal haemorrhage
Haematoma
Haematoma (injection site)
Haematoma infection
Haemodynamic disturbances
Haemoptysis
Haemorrhage
Hypersensitivity reactions
Increase in creatinine
Intracranial bleeding
Menorrhagia
Ocular haemorrhage
Pelvic haemorrhage
Penile haemorrhage
Pericardial haemorrhage
Periorbital haematoma
Peritoneal haematoma
Petechiae
Pruritus
Pulmonary haemorrhage
Purpura
Rash
Reduced platelet count
Reduction in blood count
Retroperitoneal bleeding
Skin neoplasm bleeding
Subcutaneous haematoma (injection site)
Thrombocytopenia
Urinary tract bleeding
Urticaria
Vascular pseudoaneurysm
Wound haemorrhage
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: July 2019
Reference Sources
Summary of Product Characteristics: Kengrexal 50 mg powder for concentrate for solution for injection/infusion. Chiesi Ltd. Revised December 2019.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 11 July 2019
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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