AgrylinPregnancy CategoryCategory CTher. class.
platelet reducing agent
Treatment of thrombocythemia secondary to myeloproliferative disorders.
Decreases maturation of megakaryocytes (platelet precursors).
Reduction in platelet count with reduced risk of complications associated with thrombocythemia (thrombosis).
Absorption: Well absorbed after oral administration.
Metabolism and Excretion: Extensively metabolized; <1% excreted unchanged in urine.
Half-life: 1.3 hr.
TIME/ACTION PROFILE (↓ in platelet count)
|PO||714 days||412 wk||4 days|
Increase in platelet count after discontinuation
Severe hepatic impairment;
Lactation: Potential toxic effects in infant.Use Cautiously in:
Cardiovascular, renal or mild to moderate hepatic impairment (monitor closely during treatment);
OB: Has been used safely in pregnant women and children <16 yr .
Adverse Reactions/Side Effects
CNS: SEIZURES, dizziness, headache, malaise.
EENT: abnormal vision.
Resp: EOSINOPHILIC PNEUMONIA, INTERSTITIAL PNEUMONITIS, PULMONARY FIBROSIS, PULMONARY HYPERTENSION, cough, dyspnea, pharyngitis.
CV: CARDIOMYOPATHY, CEREBROVASCULAR ACCIDENT, COMPLETE HEART BLOCK, HF, MI, chest pain, edema, palpitations, angina, atrial fibrillation, pericarditis, pericardial effusion, orthostatic hypotension, tachycardia.
GI: GI BLEEDING, HEPATOTOXICITY, PANCREATITIS, abdominal pain, diarrhea, flatulence, anorexia, constipation, dyspepsia, nausea, vomiting.
GU: RENAL FAILURE, dysuria, hematuria.
Derm: alopecia, pruritis, rash.
MS: arthralgia, back pain, myalgia, weakness.
*CAPITALS indicates life-threatening.
*italic indicates most frequent.
Absorption may be ↓ by sucralfate .
Fluvoxamine may ↑ blood levels.
May ↑ blood levels of theophylline .
May ↑ effects of milrinone and cilostazol .
PO (Adults): 0.5 mg 4 times daily or 1 mg twice daily; may be ↑ weekly by 0.5 mg/day (not to exceed 10 mg/day or 2.5 mg as a single dose)..
PO (Children): 0.5 mg daily; may be ↑ weekly by 0.5 mg/day (not to exceed 10 mg/day or 2.5 mg as a single dose..Hepatic Impairment
PO (Adults): Initiate at 0.5 mg daily; may be ↑ weekly by 0.5 mg/day..
Capsules: 0.5 mg, 1 mg
Monitor BP during initial therapy and periodically thereafter. May cause hypotension, especially upon standing.
Assess cardiovascular status before initiation of therapy and periodically during therapy. May cause vasodilation, tachycardia, palpitations, and heart failure. Close cardiovascular monitoring is required for patients with moderate hepatic impairment.
Monitor for signs and symptoms of interstitial lung diseases (progressive dyspnea with lung infiltrations). May occur from 1 week to several years after initiating anagrelide. Symptoms usually improve after discontinuation of anagrelide.Lab Test Considerations
Monitor platelet count every 2 days during first wk of therapy and weekly until maintenance dose is reached. Platelet count usually begins to drop within 714 days.
» Monitor AST and ALT prior to and periodically during therapy.
» Monitor hemoglobin, WBC, BUN, and serum creatinine during the first 2 wk of therapy.
Potential Nursing Diagnoses
Ineffective tissue perfusion (Indications)
Deficient knowledge , related to medication regimen (Patient/Family Teaching)
Dose should be reduced to the lowest possible to maintain platelet count of <600,000/mcl. Most patients experience an adequate response at a dose of 1.53 mg/day.
» Interruption of therapy is usually followed by an increase in platelet count within 4 days.
: May be taken without regard to food.
Instruct patient to take medication as directed.
May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Caution patient to stand slowly.
Advise patient to use contraception during therapy and to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. May cause fetal harm.
Instruct patient to limit alcohol intake as it may worsen the side effects of anagrelide.
Maintenance of platelet count at <600,000/mcl or decrease of ≥50% from baseline. Initial response is expected in 714 days with complete response in 412 wks.