Pronunciation
a-NA-gre-lide [Pronunciation]

Trade Name(s)

• Agrylin

Pregnancy Category
Category C

Ther. class.
platelet reducing agent

Treatment of thrombocythemia secondary to myeloproliferative disorders.

Decreases maturation of megakaryocytes (platelet precursors).

Therapeutic Effect(s):
Reduction in platelet count with reduced risk of complications associated with thrombocythemia (thrombosis).

Absorption: Well absorbed after oral administration.

Distribution: Unknown.

Metabolism and Excretion: Extensively metabolized; <1% excreted unchanged in urine.

Half-life: 1.3 hr.

TIME/ACTION PROFILE (↓ in platelet count)

ROUTE	ONSET	PEAK	DURATION
PO	7–14 days	4–12 wk	4 days†

†Increase in platelet count after discontinuation

Contraindicated in:

• Hypersensitivity;

• 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 .

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.

Hemat: anemia.

MS: arthralgia, back pain, myalgia, weakness.

Neuro: paresthesia.

Misc: fever.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Drug-Drug

• 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 7–14 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.

• 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 1.5–3 mg/day.

» Interruption of therapy is usually followed by an increase in platelet count within 4 days.

• PO: 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 7–14 days with complete response in 4–12 wks.