This site is intended for U.S. healthcare professionals only.

Dosing and Administration for KENGREAL® (cangrelor)

Preparation

KENGREAL® is intended for IV administration as a bolus and infusion, after reconstitution and dilution.1

Reconstitute

Reconstitute each 50 mg vial by adding 5 mL of Sterile Water for Injection. Swirl gently until all material is dissolved. Avoid vigorous mixing. Allow any foam to settle. Reconstituted KENGREAL® will be a clear, colorless to pale yellow solution. Product should not contain particulate matter. Do not use without dilution.1

Dilute

  • Dilute with Normal Saline (Sodium Chloride Injection 0.9% USP) or 5% Dextrose Injection USP. Withdraw the contents from one reconstituted vial and add to one 250 mL saline bag, and mix thoroughly. Final concentration = 200 mcg/mL and one bag should be sufficient for at least 2 hours of dosing. Patients 100 kg and over require a minimum of 2 bags.1
  • Dilute KENGREAL® immediately after reconstitution. Diluted KENGREAL® is stable for up to 12 hours in 5% Dextrose Injection and 24 hours in Normal Saline at Room Temperature. Discard any unused portion of reconstituted solution remaining in the vial.1

Recommended dosing

*The recommended dosage of KENGREAL® is a 30 mcg/kg IV bolus followed immediately by a 4 mcg/kg/min IV infusion.1

Administration of bolus and infusion

Administer KENGREAL® via a dedicated IV line.1

Step
1
REMOVE the bolus dose from the diluted solution, never from the reconstituted vial. 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.1
+
Step
2
BEGIN the infusion immediately after the bolus, and continue for at least 2 hours or the duration of the procedure, whichever is longer1

PCI dosing table — IV bolus and infusion1

Patient Weight
Step
1
Bolus
30mcg/kg
+
Step
2
Infusion rate
4mcg/kg/min*
lbs
kg
mL
mL/hour
83-93
38-42
6
48
94-104
43-47
7
54
105-115
48-52
7.5
60
116-126
53-57
8
66
127-137
58-62
9
72
138-148
63-67
10
78
149-159
68-72
10.5
84
160-170
73-77
11
90
171-181
78-82
12
96
182-192
83-87
13
102
193-203
88-92
13.5
108
204-214
93-97
14
114
215-225
98-102
15
120
226-236
103-107
16
126
237-247
108-112
16.5
132
248-258
113-117
17
138
259-269
118-122
18
144
270-280
123-127
19
150
281-291
128-132
19.5
156
292-302
133-137
20
162
303-313
138-142
21
168
314-324
143-147
22
174
325-335
148-152
22.5
180
336-346
153-157
23
186
347-357
158-162
24
192
358-368
163-167
25
198
369-379
168-172
25.5
204
380-390
173-177
26
210
391-401
178-182
27
216
402-412
183-187
28
222
413-423
188-192
28.5
228
424-434
193-197
29
234
435-445
198-202
30
240
446-456
203-207
31
246
457-467
208-212
31.5
252

Conversion from pounds (lbs) to kilograms (kg): lbs x 0.45 = kg. Please see dosing formulas below.

Specific populations

Pharmacokinetics is not affected by sex, age, renal status, or hepatic function.

No dose adjustments are needed for these factors.

KENGREAL® should not be used during pregnancy and it is not known whether KENGREAL® is excreted in human milk.1

Please refer to Prescribing Information for additional information

Drug-drug interactions

If clopidogrel or prasugrel are administered during KENGREAL® infusion, they will have no antiplatelet effect until the next dose is administered. Clopidogrel and prasugrel, therefore, should not be administered until KENGREAL® infusion is discontinued.1

Co-administration of cangrelor with unfractionated heparin, aspirin, and nitroglycerin was formally studied in healthy subjects, with no evidence of an effect on the PK/PD of cangrelor.1

In clinical trials cangrelor has been co-administered with bivalirudin, low molecular weight heparin, clopidogrel, prasugrel, and ticagrelor without clinically detectable interactions.1

The expected antiplatelet effect of a 600 mg loading dose of clopidogrel or a 60 mg loading dose of prasugrel was blocked when clopidogrel or prasugrel was administered during a cangrelor infusion.1

In contrast, the antiplatelet effect of a 180 mg ticagrelor loading dose was not altered significantly when ticagrelor was administered during cangrelor infusion.1

KENGREAL® dosing formulas1

Dosing Formulas

Transitioning patients to oral P2Y12 therapy

To maintain platelet inhibition after discontinuation of KENGREAL® infusion, an oral P2Y12 platelet inhibitor should be administered. Administer one as described below1:

  • Ticagrelor: 180 mg at any time during KENGREAL® infusion or immediately after discontinuation.
  • Prasugrel: 60mg immediately after discontinuation of KENGREAL®. Do not administer prasugrel prior to discontinuation of KENGREAL®.
  • Clopidogrel: 600 mg immediately after discontinuation of KENGREAL®. Do not administer clopidogrel prior to discontinuation of KENGREAL®.

How supplied/storage and handling1

KENGREAL® is supplied as a sterile lyophilized powder in single use 10 mL vials.

  • NDC 65293-003-01: 10 mL vial containing 50 mg cangrelor
  • NDC 65293-003-10: 10 count of 10 mL vials containing 50 mg cangrelor

Vials of KENGREAL® should be stored at USP Controlled Room Temperature [20°C to 25°C (68°F to 77°F) with excursions between 15°C and 30°C (59°F and 86°F) permitted].

Reference: 1. KENGREAL® (cangrelor) Prescribing Information. 2016.

Important Safety Information

KENGREAL® (cangrelor) for Injection is contraindicated in patients with significant active bleeding.

KENGREAL® is contraindicated in patients with known hypersensitivity (e.g., anaphylaxis) to cangrelor or any component of the product.

Drugs that inhibit platelet P2Y12 function, including KENGREAL®, increase the risk of bleeding. In CHAMPION PHOENIX, bleeding events of all severities were more common with KENGREAL® than with clopidogrel. Bleeding complications with KENGREAL® were consistent across a variety of clinically important subgroups. Once KENGREAL® is discontinued, there is no antiplatelet effect after an hour.

The most common adverse reaction is bleeding.

Please see full prescribing information.

www.kengreal.com

This site is intended for U.S. healthcare professionals. If you are a U.S. healthcare professional, click OK to continue.

Cancel
Ok