KENGREAL® (cangrelor) Dosing and Administration

Dosing that is independent of age, renal function, or hepatic function1

Dosing and administration

KENGREAL is administered as a bolus and infusion after reconstitution and dilution.1

Watch the video to learn how to prepare KENGREAL

Kengreal Dosing and Administration video
KENGREAL® (cangrelor) 50mg vial and packaging

Reconstitute and dilute1

Supplied as a sterile, lyophilized powder in 10 mL single-use vials, each containing 50 mg of KENGREAL

Download the Dosing & Administration Guide for KENGREAL


Reconstitute the contents of the vial immediately before dilution.

  • Add 5 mL of sterile water for injection to one 50 mg vial
  • 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 reconstituted solution of KENGREAL without dilution.


Dilution can be in either 0.9% sodium chloride injection USP or 5% dextrose injection USP:

  • Add contents from one reconstituted vial to one 250 mL saline or dextrose bag and mix thoroughly
  • Final concentration = 200 mcg/mL; sufficient for at least 2 hours of dosing. Patients 100 kg and over require a minimum of 2 bags

Diluted KENGREAL is stable at room temperature for up to 12 hours in 5% dextrose injection and 24 hours in normal saline. Discard any unused portion of reconstituted solution remaining in the vial.

Dose KENGREAL according to patient weight1

The recommended dosage of KENGREAL is a 30 mcg/kg IV bolus immediately followed by a 4 mcg/kg/min IV infusion. Be sure to administer KENGREAL via a dedicated IV line.1

Bolus (mL):

30 mcg/kg x body weight (kg)

200 mcg/mL

Step 1
  • Remove the bolus dose from the IV bag, never from the reconstituted vial
  • Use manual IV push or pump to administer the bolus volume in <1 minute
  • Ensure the bolus is completely administered before the start of PCI

Infusion (mL/hr):

4 mcg/kg/min x 60 min/hr x body weight (kg)

200 mcg/mL

Step 2
  • Begin the infusion immediately after the bolus
  • Continue for at least 2 hours or the duration of the procedure, whichever is longer

Dosing Table

lbskgBolus 30 mcg/kgmLmL/hourInfusion rate 4 mcg/kg/minPatient WeightStep 1Step 283-9394-104105-115116-126127-137138-148149-159160-170171-181182-192193-203204-214215-225226-236237-247248-258259-269270-280281-291292-302303-313314-324325-335336-346347-357358-368369-379380-390391-401402-412413-423424-434435-445446-456457-46738-4243-4748-5253-5758-6263-6768-7273-7778-8283-8788-9293-9798-102103-107108-112113-117118-122123-127128-132133-137138-142143-147148-152153-157158-162163-167168-172173-177178-182183-187188-192193-197198-202203-207208-212677.5891010.511121313.514151616.517181919.520212222.523242525.526272828.529303131.5485460667278849096102108114120126132138144150156162168174180186192198204210216222228234240246252

No age-based dose adjustment is required in elderly patients (≥75 years) or for patients with renal or hepatic insufficiency.

See more doses

Dosing guidelines1

  • Adjust KENGREAL dose based on patient weight to meet the recommended 30 mcg/kg IV bolus and 4 mcg/kg/min IV infusion
    • Remove the bolus from the IV bag, never from the reconstituted vial
  • Dose adjustment is not required in elderly patients (≥75 years) or in patients with renal or hepatic insufficiency
  • Maintenance infusion should be continued for at least 2 hours or for the duration of the PCI, whichever is longer
  • To maintain platelet inhibition after discontinuation of KENGREAL infusion, an oral P2Y12 platelet inhibitor should be administered

Transitioning patients to an oral P2Y12 inhibitor

To maintain platelet inhibition after discontinuation of KENGREAL infusion, an oral P2Y12 inhibitor should be administered as follows1:


Drug icon 1

180 mg at any time during KENGREAL infusion or immediately after discontinuation


Drug icon 2

60 mg immediately after KENGREAL discontinuation*

Do not administer prior to KENGREAL discontinuation


Drug icon 3

600 mg immediately after KENGREAL discontinuation*

Do not administer prior to KENGREAL discontinuation

*If prasugrel or clopidogrel is administered during KENGREAL infusion, it will have no antiplatelet effect until the next dose is administered.

Transition rationale based on P2Y12 binding site interactions2-6

KENGREAL is an ATP analogue that binds to the same receptor site as ADP


Signaling Inhibition Image 1


Thienopyridines (active metabolite): clopidogrel and prasugrel

Signaling Inhibition Image 2


CPTP: ticagrelor

Signaling Inhibition Image 3


ATP: KENGREAL® (cangrelor)

Signaling Inhibition Image 4


KENGREAL® (cangrelor) molecule blocks active metabolite of thienopyridines binding site

Signaling Inhibition Image 5


CPTP (ticagrelor) is still able to bind to P2Y12 receptor even while KENGREAL is active

Signaling Inhibition Image 6


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.


KENGREAL® (cangrelor) for Injection is a P2Y12 platelet inhibitor indicated as an adjunct to percutaneous coronary intervention (PCI) to reduce the risk of periprocedural myocardial infarction (MI), repeat coronary revascularization, and stent thrombosis (ST) in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a glycoprotein IIb/IIIa inhibitor.

References: 1. KENGREAL® (cangrelor) Prescribing Information. 2020. 2. Capodanno D, Ferreiro JL, Angiolillo DJ. Antiplatelet therapy: new pharmacological agents and changing paradigms. J Thromb Haemost. 2013;11(suppl 1):316-329. 3. Schneider DJ, Agarwal Z, Seecheran N, Keating FK, Gogo P. Pharmacodynamic effects during the transition between cangrelor and ticagrelor. JACC Cardiovasc Interv. 2014;7(4):435-442. 4. Schneider DJ, Agarwal Z, Seecheran N, Gogo P. Pharmacodynamic effects when clopidogrel is given before cangrelor discontinuation. J Interven Cardiol. 2015;28(5):415-419. 5. Schneider DJ, Seecheran N, Raza SS, Keating FK, Gogo P. Pharmacodynamic effects during the transition between cangrelor and prasugrel. Coron Artery Dis. 2015;26(1):42-48. 6. Rollini F, Franchi F, Angiolillo DJ. Switching P2Y12-receptor inhibitors in patients with coronary artery disease. Nat Rev Cardiol. 2016;13(1):11-27. 7. Stone GW, Généreux P, Harrington RA, et al. Impact of lesion complexity on peri-procedural adverse events and the benefit of potent intravenous platelet adenosine diphosphate receptor inhibition after percutaneous coronary intervention: core laboratory analysis from 10,854 patients from the CHAMPION PHOENIX trial. Eur Heart J. 2018;39(46):4112-4121.