Cangrelor

Pregnancy Category: C

Lactation: Unknown if distributed in human breast milk; use caution

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

Mechanism of Action

P2Y12 platelet inhibitor that blocks ADP-induced platelet activation and aggregation; it binds selectively and reversibly to the P2Y12 receptor to prevent further signaling and platelet activation

Absorption

Peak plasma concentration: 2 minutes

Onset of action: Within 2 minutes following 30 mcg/kg IV bolus followed by 4 mcg/kg/min IV infusion

After discontinuation of the infusion, the antiplatelet effect decreases rapidly and platelet function returns to normal within 1 hr

Distribution

Protein bound 97-98%

Vd: 3.9 L

Metabolism

Deactivated rapidly in the circulation by dephosphorylation to its primary metabolite, a nucleoside, which has negligible antiplatelet activity

Metabolism is independent of hepatic function and it does not interfere with other drugs metabolized by hepatic enzymes

Elimination

Half-life: 3-6 minutes

Excretion: 58% urine; 35% feces

• Cangrelor is administered by intravenous (IV) infusion. The recommended dose is a 30 mcg/kg IV bolus before PCI followed immediately by a 4 mcg/kg/min IV maintenance infusion.
• The maintenance infusion should be continued for at least 2 hours or for the duration of PCI, whichever is longer.

• Use of cangrelor in pregnant females has not been adequately studied.
• It is not known whether cangrelor is excreted in human milk.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• Other medications that inhibit platelet activation and aggregation, including clopidogrel (Plavix) and prasugrel (Effient)

This is not a complete list of cangrelor drug interactions. Ask your doctor or pharmacist for more information.

If you take too much cangrelor, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If cangrelor is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

• If you need to store this medicine at home, talk with your doctor, nurse, or pharmacist about how to store it.

Platelet inhibition occurs within 2 minutes

Time to Peak

Within 2 minutes

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; hematuria; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding) (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating, and advising patients.