Details of Drug Interaction | MecDDI

Drug General Information (ID: DDINZGYS0O)
Drug Name			Clopidogrel		Drug Info		Cangrelor		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiplatelet Agents				Antiplatelet Agents
Structure

Mechanism of Clopidogrel-Cangrelor Interaction (Severity Level: Major)
Attenuated pharmacological effects (Unspecific) Click to Show/Hide Mechanism Graph
Drug Name		Clopidogrel				Cangrelor
Mechanism		Clopidogrel Irreversible P2Y12 inhibitor Inhibitor				Decrease the antiplatelet activities of clopidogrel Reversible P2Y12 inhibitor Inhibitor
Key Mechanism Factor 1
		Factor Name		P2Y purinoceptor 12				× Structure Sequence MQAVDNLTSAPGNTSLCTRDYKITQVLFPLLYTVLFFVGLITNGLAMRIFFQIRSKSNFIIFLKNTVISDLLMILTFPFKILSDAKLGTGPLRTFVCQVTSVIFYFTMYISISFLGLITIDRYQKTTRPFKTSNPKNLLGAKILSVVIWAFMFLLSLPNMILTNRQPRDKNVKKCSFLKSEFGLVWHEIVNYICQVIFWINFLIVIVCYTLITKELYRSYVRTRGVGKVPRKKVNVKVFIIIAVFFICFVPFHFARIPYTLSQTRDVFDCTAENTLFYVKESTLWLTSLNACLDPFIYFFLCKSFRNSLISMLKCPNSATSLSQDNRKKEQDGGDPNEETPM
		Gene Name		P2RY12
		Uniprot ID		P2Y12_HUMAN
		KEGG Pathway		hsa:64805
		Protein Family		G-protein coupled receptor 1 family
		Protein Function		Receptor for ADP and ATP coupled to G-proteins that inhibit the adenylyl cyclase second messenger system. Not activated by UDP and UTP. Required for normal platelet aggregation and blood coagulation. Click to Show/Hide
Key Mechanism Factor 2
		Factor Name		P2Y purinoceptor 12				× Structure Sequence MQAVDNLTSAPGNTSLCTRDYKITQVLFPLLYTVLFFVGLITNGLAMRIFFQIRSKSNFIIFLKNTVISDLLMILTFPFKILSDAKLGTGPLRTFVCQVTSVIFYFTMYISISFLGLITIDRYQKTTRPFKTSNPKNLLGAKILSVVIWAFMFLLSLPNMILTNRQPRDKNVKKCSFLKSEFGLVWHEIVNYICQVIFWINFLIVIVCYTLITKELYRSYVRTRGVGKVPRKKVNVKVFIIIAVFFICFVPFHFARIPYTLSQTRDVFDCTAENTLFYVKESTLWLTSLNACLDPFIYFFLCKSFRNSLISMLKCPNSATSLSQDNRKKEQDGGDPNEETPM
		Gene Name		P2RY12
		Uniprot ID		P2Y12_HUMAN
		KEGG Pathway		hsa:64805
		Protein Family		G-protein coupled receptor 1 family
		Protein Function		Receptor for ADP and ATP coupled to G-proteins that inhibit the adenylyl cyclase second messenger system. Not activated by UDP and UTP. Required for normal platelet aggregation and blood coagulation. Click to Show/Hide
Mechanism Description		Attenuated pharmacological effects of Clopidogrel when combined with Cangrelor

Recommended Action
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.

References
1	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
2	Product Information. Kengreal (cangrelor). The Medicines Company, Parsippany, NJ.
3	Dovlatova NL, Jakubowski JA, Sugidachi A, Heptinstall S "The reversible P2Y antagonist cangrelor influences the ability of the active metabolites of clopidogrel and prasugrel to produce irreversible inhibition of platelet function." J Thromb Haemost 6 (2008): 1153-9.[PMID: 18485086]