Drug Interaction Report

ADJUST DOSING INTERVAL: The antiplatelet effect of clopidogrel or prasugrel may be inhibited when they are administered at the same time as cangrelor. The mechanism is competitive inhibition of P2Y12 platelet receptors by cangrelor, which, unlike clopidogrel or prasugrel, binds reversibly at the receptor site and causes a temporary rather than persistent inhibition of ADP-induced platelet activation and aggregation. According to the product labeling for cangrelor, the expected antiplatelet effect of a 600 mg loading dose of clopidogrel or a 60 mg loading dose of prasugrel was blocked when these agents were administered during a cangrelor infusion. Conversely, pretreatment with clopidogrel or prasugrel does not impair the antiplatelet effect of cangrelor, but may result in additive platelet inhibition.

MANAGEMENT: To maintain platelet inhibition, clopidogrel 600 mg or prasugrel 60 mg should be administered immediately after discontinuation of the cangrelor infusion. Do not administer prior to discontinuation of cangrelor, as clopidogrel and prasugrel will have no antiplatelet effect until the next dose is administered. Alternatively, ticagrelor 180 mg may be administered at any time during cangrelor infusion or immediately after discontinuation.

The recommended maximum number of medicines in the 'ADP receptor antagonists' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'ADP receptor antagonists' category:

• clopidogrel
• Kengreal (cangrelor)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.