Dosing and Administration for KENGREAL® (cangrelor)
KENGREAL® is intended for IV administration as a bolus and infusion, after reconstitution and dilution.1
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 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
*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
PCI dosing table — IV bolus and infusion1
Conversion from pounds (lbs) to kilograms (kg): lbs x 0.45 = kg. Please see dosing formulas below.
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
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
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.