Dosing & Uses
Dosage Forms & Strengths
capsule
- 0.5mg
- 1mg
Thrombocythemia
Indicated for essential thrombocythemia and for thrombocythemia secondary to myeloproliferative disorders to decrease risk thrombosis and thrombo-hemorrhagic event
0.5 PO q6hr or 1 mg q12hr; increase PRN not more frequently than 0.5 mg/day/week
Not to exceed 10 mg/day or 2.5 mg/dose
Platelet count responds typically in 7-14 days; time to complete response is 4 to 12 weeks
Polycythemia Vera (Orphan)
Orphan indication sponsor
- Roberts Pharmaceutical Corp; Meridian Center II, 4 Industrial Way West; Eatontown, NJ 07724-2274
Hepatic Impairment
Moderate: Start with 0.5 mg/day for at least 1 week; increase PRN no more frequently than 0.5 mg/day/week
Severe: Contraindicated
Monitor
Platelet count
Dosage Forms & Strengths
capsule
- 0.5mg
- 1mg
Thrombocythemia
<7 years
- Safety and efficacy not established
≥7 years
- 0.5 mg/day to 0.5 mg PO q6hr; adjust dose PRN no more frequently than 0.5 mg/day/week
- Platelet count responds typically in 7-14 days; time to complete response is 4 to 12 weeks
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (7)
- abrocitinib
abrocitinib and anagrelide both increase anticoagulation. Contraindicated. Antiplatelet drugs, except for low-dose aspirin (=81 mg qDay), during the first 3 months of treatment are contraindicated.
- dronedarone
anagrelide and dronedarone both increase QTc interval. Contraindicated.
- goserelin
goserelin increases toxicity of anagrelide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- histrelin
histrelin increases toxicity of anagrelide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- leuprolide
leuprolide increases toxicity of anagrelide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- thioridazine
anagrelide and thioridazine both increase QTc interval. Contraindicated.
- triptorelin
triptorelin increases toxicity of anagrelide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
Serious - Use Alternative (138)
- alfuzosin
alfuzosin and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- amiodarone
anagrelide and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
anagrelide and amisulpride both increase QTc interval. Avoid or Use Alternate Drug.
- antithrombin alfa
antithrombin alfa, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- antithrombin III
antithrombin III, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- apixaban
anagrelide and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.
- apomorphine
apomorphine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- argatroban
argatroban, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- arsenic trioxide
anagrelide and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
artemether/lumefantrine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
anagrelide and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
asenapine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug. - asenapine transdermal
asenapine transdermal and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- aspirin rectal
aspirin rectal increases effects of anagrelide by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.
- azithromycin
anagrelide and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- bedaquiline
bedaquiline and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- bivalirudin
bivalirudin, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- buprenorphine
anagrelide and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
buprenorphine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug. - buprenorphine buccal
buprenorphine buccal and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- caplacizumab
caplacizumab, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- chloroquine
chloroquine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
anagrelide and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.
- ciprofloxacin
anagrelide and ciprofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- citalopram
citalopram and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- crizotinib
crizotinib and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- dalteparin
dalteparin, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- dasatinib
dasatinib and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- degarelix
degarelix and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- disopyramide
anagrelide and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- dofetilide
anagrelide and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- dolasetron
dolasetron and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- donepezil
donepezil and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- droperidol
anagrelide and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- efavirenz
efavirenz and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- eliglustat
anagrelide and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and anagrelide both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.
- enoxaparin
enoxaparin, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- entrectinib
anagrelide and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
eribulin and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin base
anagrelide and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
anagrelide and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
anagrelide and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
anagrelide and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and anagrelide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
- fingolimod
fingolimod and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- flecainide
anagrelide and flecainide both increase QTc interval. Avoid or Use Alternate Drug.
- fluconazole
anagrelide and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
anagrelide and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
anagrelide and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.
- fondaparinux
fondaparinux, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- foscarnet
anagrelide and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.
- gemifloxacin
gemifloxacin and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- gilteritinib
gilteritinib and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- glasdegib
anagrelide and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.
- granisetron
granisetron and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- haloperidol
anagrelide and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
- heparin
heparin, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- hydroxychloroquine sulfate
anagrelide and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxyzine
hydroxyzine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- ibutilide
anagrelide and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.
- iloperidone
anagrelide and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
inotuzumab and anagrelide both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.
- isoflurane
isoflurane and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- itraconazole
itraconazole and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
anagrelide and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.
- lapatinib
anagrelide and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- levofloxacin
anagrelide and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- lithium
lithium and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- loperamide
anagrelide and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- lopinavir
anagrelide and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
anagrelide and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.
- maprotiline
anagrelide and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.
- mefloquine
anagrelide and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.
- methadone
anagrelide and methadone both increase QTc interval. Avoid or Use Alternate Drug.
- midostaurin
anagrelide and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.
- mifepristone
anagrelide and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- mirtazapine
mirtazapine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
anagrelide and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.
- moxifloxacin
anagrelide and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nilotinib
anagrelide and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- octreotide
anagrelide and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- ofloxacin
anagrelide and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- olanzapine
olanzapine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- ondansetron
anagrelide and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.
- osimertinib
anagrelide and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.
- oxaliplatin
anagrelide and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.
- ozanimod
anagrelide and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.
- paliperidone
anagrelide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
anagrelide and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.
- pasireotide
anagrelide and pasireotide both increase QTc interval. Avoid or Use Alternate Drug.
- pazopanib
anagrelide and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.
- pentamidine
anagrelide and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- pimavanserin
pimavanserin and anagrelide both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.
- pimozide
anagrelide and pimozide both increase QTc interval. Contraindicated.
- pitolisant
anagrelide and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- ponesimod
anagrelide and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.
- posaconazole
anagrelide and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.
- primaquine
primaquine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- procainamide
anagrelide and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- promethazine
anagrelide and promethazine both decrease QTc interval. Avoid or Use Alternate Drug.
- propafenone
anagrelide and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- protamine
protamine, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.
- quetiapine
anagrelide and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
anagrelide and quinidine both increase QTc interval. Avoid or Use Alternate Drug.
- ranolazine
anagrelide and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.
- ribociclib
ribociclib and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- rilpivirine
anagrelide and rilpivirine both increase QTc interval. Avoid or Use Alternate Drug.
- risperidone
anagrelide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.
- romidepsin
anagrelide and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.
- saquinavir
anagrelide and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.
- selpercatinib
anagrelide and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.
- sertraline
sertraline and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- sevoflurane
sevoflurane and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
siponimod and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- solifenacin
solifenacin and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- sorafenib
anagrelide and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- sotalol
anagrelide and sotalol both increase QTc interval. Avoid or Use Alternate Drug.
- sunitinib
sunitinib and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
anagrelide and sunitinib both increase QTc interval. Avoid or Use Alternate Drug. - tacrolimus
tacrolimus and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
anagrelide and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug. - telavancin
anagrelide and telavancin both increase QTc interval. Avoid or Use Alternate Drug.
- tetrabenazine
anagrelide and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- toremifene
anagrelide and toremifene both increase QTc interval. Avoid or Use Alternate Drug.
- trazodone
anagrelide and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
- vandetanib
anagrelide and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.
- vardenafil
anagrelide and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.
- vemurafenib
anagrelide and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.
- venlafaxine
anagrelide and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.
- voclosporin
anagrelide and voclosporin both increase QTc interval. Avoid or Use Alternate Drug.
- voriconazole
anagrelide and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.
- vorinostat
anagrelide and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.
vorinostat and anagrelide both increase QTc interval. Avoid or Use Alternate Drug. - ziprasidone
anagrelide and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (57)
- albuterol
albuterol and anagrelide both increase QTc interval. Use Caution/Monitor.
- arformoterol
arformoterol and anagrelide both increase QTc interval. Use Caution/Monitor.
- aripiprazole
aripiprazole and anagrelide both increase QTc interval. Use Caution/Monitor.
- aspirin
aspirin, anagrelide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; increases risk of bleeding; monitor closely.
anagrelide, aspirin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; increases risk of bleeding; monitor closely. - aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate, anagrelide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.
- atomoxetine
atomoxetine and anagrelide both increase QTc interval. Use Caution/Monitor.
- azficel-T
azficel-T, anagrelide. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.
- betrixaban
anagrelide, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.
- cilostazol
anagrelide, cilostazol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
- citalopram
citalopram increases effects of anagrelide by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.
- clomipramine
anagrelide and clomipramine both increase QTc interval. Use Caution/Monitor.
- clozapine
clozapine and anagrelide both increase QTc interval. Use Caution/Monitor.
- dabigatran
dabigatran, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.
- deferasirox
deferasirox, anagrelide. Other (see comment). Use Caution/Monitor. Comment: Acute renal failure has been reported during treatment with deferasirox. Coadministration of deferasirox with other potentially nephrotoxic drugs, including aminoglycosides, may increase the risk of this toxicity. Monitor serum creatinine and/or creatinine clearance in patients who are receiving deferasirox and nephrotoxic drugs concomitantly.
- desipramine
anagrelide and desipramine both increase QTc interval. Use Caution/Monitor.
- deutetrabenazine
anagrelide and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- doxepin
doxepin and anagrelide both increase QTc interval. Use Caution/Monitor.
- escitalopram
anagrelide and escitalopram both increase QTc interval. Use Caution/Monitor.
- etrasimod
etrasimod, anagrelide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Transient decrease in heart rate and AV conduction delays may occur when initiating etrasimod. Owing to potential of additive effect on heart rate, etrasimod may increase risk of QT prolongation and Torsades de Pointes when coadministered with Class Ia or Class III antiarrhythmic drugs, or other drugs that prolong the QT interval. .
- fish oil
fish oil, anagrelide. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .
- fish oil triglycerides
fish oil triglycerides will increase the level or effect of anagrelide by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.
- fluphenazine
anagrelide and fluphenazine both increase QTc interval. Use Caution/Monitor.
- fostemsavir
anagrelide and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gemtuzumab
anagrelide and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- green tea
green tea increases effects of anagrelide by pharmacodynamic synergism. Use Caution/Monitor. (Theoretical interaction). Combination may increase risk of bleeding.
- ibrutinib
ibrutinib will increase the level or effect of anagrelide by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.
- icosapent
icosapent, anagrelide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.
- imipramine
anagrelide and imipramine both increase QTc interval. Use Caution/Monitor.
- inamrinone
anagrelide, inamrinone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
- lenvatinib
anagrelide and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.
- lofexidine
anagrelide and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.
- lurasidone
lurasidone increases effects of anagrelide by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
- melatonin
melatonin increases effects of anagrelide by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.
- milrinone
anagrelide, milrinone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
- nortriptyline
anagrelide and nortriptyline both increase QTc interval. Use Caution/Monitor.
- omega 3 carboxylic acids
omega 3 carboxylic acids, anagrelide. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.
- omega 3 fatty acids
omega 3 fatty acids, anagrelide. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .
- osilodrostat
osilodrostat and anagrelide both increase QTc interval. Use Caution/Monitor.
- oxaliplatin
oxaliplatin will increase the level or effect of anagrelide by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- paroxetine
anagrelide and paroxetine both increase QTc interval. Use Caution/Monitor.
- perphenazine
anagrelide and perphenazine both increase QTc interval. Use Caution/Monitor.
- porfimer
anagrelide decreases effects of porfimer by pharmacodynamic antagonism. Use Caution/Monitor.
- prochlorperazine
anagrelide and prochlorperazine both decrease QTc interval. Use Caution/Monitor.
- protriptyline
anagrelide and protriptyline both increase QTc interval. Use Caution/Monitor.
- quinine
anagrelide and quinine both increase QTc interval. Use Caution/Monitor.
- rivaroxaban
rivaroxaban, anagrelide. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.
- selumetinib
anagrelide and selumetinib both increase anticoagulation. Modify Therapy/Monitor Closely. An increased risk of bleeding may occur in patients taking a vitamin-K antagonist or an antiplatelet agent with selumetinib. Monitor for bleeding and INR or PT in patients coadministered a vitamin-K antagonist or an antiplatelet agent with selumetinib.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of anagrelide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of anagrelide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias.
- ticagrelor
ticagrelor, anagrelide. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.
- triclabendazole
triclabendazole and anagrelide both increase QTc interval. Use Caution/Monitor.
- trifluoperazine
anagrelide and trifluoperazine both decrease QTc interval. Use Caution/Monitor.
- trimipramine
anagrelide and trimipramine both increase QTc interval. Use Caution/Monitor.
- valbenazine
valbenazine and anagrelide both increase QTc interval. Use Caution/Monitor.
- vorapaxar
anagrelide, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.
- vortioxetine
anagrelide, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.
- warfarin
anagrelide, warfarin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Drugs with antiplatelet properties may increase anticoagulation effect of warfarin.
Minor (7)
- devil's claw
devil's claw, anagrelide. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.
- food
food decreases levels of anagrelide by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- ginger
ginger, anagrelide. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.
- ginkgo biloba
ginkgo biloba, anagrelide. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.
- horse chestnut seed
horse chestnut seed, anagrelide. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Theoretical. Use with caution.
- sucralfate
sucralfate decreases levels of anagrelide by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- verteporfin
anagrelide decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.
Adverse Effects
>10%
Headache (44%)
Palpitations (26%)
Diarrhea (26%)
Asthenia (23%)
Edema (21%)
Nausea (17%)
Abdominal pain (16%)
Dizziness (15%)
General pain (15%)
Dyspnea (12%)
1-10%
Flatulence (10%)
Vomiting (10%)
Fever (9%)
Edema (9%)
Rash (8%)
Chest pain (8%)
Anorexia (8%)
Tachycardia (8%)
Pharyngitis (7%)
Malaise (6%)
Cough (6%)
Paresthesia (6%)
Back pain (6%)
Pruritus (6%)
Confusion (1-5%)
Depression
Migraine
Myalgia
Nervousness
Photosensitivity
Arthralgia
Vision abnormalities
Angina
Arrhythmia
Cardiovascular disease
Heart failure
Hemorrhage
Hypertension
Postural hypotension
Syncope
Thrombosis
Vasodilation
Bronchitis
Rhinitis
Sinusitis
Constipation
Dyspepsia
Gastritis
Anemia
Elevated liver enzymes
Flu symptoms
Leg cramps
Dehydration
Postmarketing Reports
Interstitial lung diseases, including allergic alveolitis, eosinophilic pneumonia and interstitial pneumonitis
Hepatotoxicity
Tubulointerstitial nephritis
Supraventricular tachycardia (SVT)
Hypoesthesia
Torsades de pointes
Cardiovascular toxicity
Pulmonary hypertension
Bleeding risk
Pulmonary toxicity
Cerebral infarction
Warnings
Contraindications
Severe hepatic impairment
Cautions
Cases of pulmonary hypertension reported; evaluate patients for signs and symptoms of underlying cardiopulmonary disease prior to initiating and during anagrelide therapy
Interstitial lung diseases (including allergic alveolitis, eosinophilic pneumonia and interstitial pneumonitis) reported to be associated with use of anagrelide in post-marketing reports; most cases presented with progressive dyspnea with lung infiltrations; time of onset ranged from 1 week to several years after initiating anagrelide; discontinue anagrelide if it occurs and evaluate; symptoms may improve after discontinuation
Monitor platelets, Hgb, WBC, LFTs, Cr, BUN for at least first 2 weeks
May induce high output heart failure by PDE4 inhibition (may be reversible upon discontinuation)
Cardiovascular toxicity
- Caution in heart disease, renal impairment, mild-moderate hepatic impairment
- Torsades de pointes and ventricular tachycardia reported; obtain pretreatment cardiovascular exam, including EKG, in all patients
- Hepatic impairment increases anagrelide exposure and could increase risk of QTc prolongation; monitor patients with hepatic impairment for QTc prolongation and other cardiovascular adverse reactions
- Increases QTc interval and heart rate in healthy volunteers; should not be used in patients with known risk factors for QT interval prolongation, such as congenital long QT syndrome, a known history of acquired QTc prolongation, medicinal products that can prolong QTc interval and hypokalemia
- In patients with cardiac disease, use only when benefits outweigh risks
- In patients with heart failure, bradyarrhythmias, or electrolyte abnormalities, consider periodic ECG monitoring
- Orthostatic hypotension reported with higher doses; minimal BP changes observed following 2 mg/dose
Drug interaction overview
- Use concomitantly with aspirin may increase risk of bleeding; assess potential risks and benefits for concomitant use with aspirin, since bleeding risks may be increased; monitor patients for bleeding, including those receiving concomitant therapy with other drugs known to cause bleeding (eg, anticoagulants, PDE3 inhibitors, NSAIDs, antiplatelet agents, selective serotonin reuptake inhibitors)
- Avoid use in patients taking medications that may prolong QT interval (including, but not limited to, chloroquine, clarithromycin, haloperidol, methadone, moxifloxacin, amiodarone, disopyramide, procainamide, and pimozide)
- Avoid use with PDE3 inhibitors such as inotropes and other PDE3 inhibitors (e.g., cilostazol, milrinone), which have similar characteristics as anagrelide
- This drug and its active metabolite are primarily metabolized by CYP1A2. Drugs that inhibit CYP1A2 (eg, fluvoxamine, ciprofloxacin) could increase exposure of anagrelide; monitor patients for cardiovascular events and titrate doses accordingly when CYP1A2 inhibitors are co-administered
- CYP1A2 inducers could decrease the exposure of this drug; patients taking concomitant CYP1A2 inducers (eg, omeprazole) may need to have their dose titrated to compensate for decrease in anagrelide exposure
- Anagrelide demonstrates limited inhibitory activity towards CYP1A2 in vitro and may alter exposure of concomitant CYP1A2 substrates (eg, theophylline, fluvoxamine, ondansetron)
Pregnancy & Lactation
Pregnancy
Available data from case reports in pregnant women have not identified drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes; in animal embryo-fetal studies, delayed fetal development (delayed skeletal ossification and reduced body weight) was observed in rats administered anagrelide hydrochloride during organogenesis at doses approximately 97 times the maximum clinical dose (10 mg/day) based on body surface area; there are adverse effects on maternal and fetal outcomes associated with thrombocythemia in pregnancy
Thrombotic events, such as stroke, deep vein thrombosis, or myocardial infarction, can be complications of thrombocythemia; thrombocythemia in pregnancy is associated with an increased risk for miscarriage, stillbirth, and other maternal outcomes, such as preeclampsia
Animal data
- In a pre- and post-natal study conducted in female rats, anagrelide hydrochloride administered at oral doses of 60 mg/kg/day (58 times the maximum clinical dose based on body surface area) or higher during organogenesis through lactation produced delay or blockage of parturition, deaths of non-delivering pregnant dams and their fully developed fetuses, and increased mortality in the pups born
Infertility
- Based on findings from animal studies, therapy may impair female fertility
Lactation
There is no information regarding presence of drug in human milk, effect on breastfed child, or on milk production; the drug or its metabolites have been detected in milk of lactating rats; because of potential for serious adverse reactions, including thrombocytopenia, in a breastfed child, advise patients that breastfeeding is not recommended during treatment, and for one week following last dose
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.Pharmacology
Mechanism of Action
Phosphodiesterase 3 (PDE3) inhibitor; inhibits nucleotide PDE and the release of arachidonic acid from phospholipase A2; reduces also platelet production by disrupting the maturation phase of megakaryocytes
Pharmacokinetics
Onset of action: Within 7-14 days (initial); 4-12 weeks (complete)
Peak plasma time: 1 hr
Duration: 6-24 hr
Metabolism: Extensive; partially through CYP1A2
Half-life: 1.3 hr
Excretion: Urine (<1%)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| anagrelide oral - | 1 mg capsule |  | |
| anagrelide oral - | 0.5 mg capsule |  | |
| anagrelide oral - | 1 mg capsule |  | |
| Agrylin oral - | 0.5 mg capsule |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
anagrelide oral
ANAGRELIDE - ORAL
(an-AG-re-lide)
COMMON BRAND NAME(S): Agrylin
USES: Anagrelide is used to treat a certain blood disorder (thrombocythemia), which is caused by your bone marrow making too many platelets. Platelets are a blood cell that the body uses to form blood clots. Too many platelets can cause problems with your circulation, including unwanted blood clots and bleeding problems. This drug reduces the number of platelets in the bloodstream by blocking their production.
HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking anagrelide and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually 2 or 4 times a day. Children or people with liver problems may start out by taking only 1 dose each day. Your doctor will adjust your dose, usually once a week, to find the best dose for you that keeps your blood counts closer to normal. The dosage is based on your medical condition and response to treatment.Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same times each day. Keep taking this medication even if you feel well. People with high platelets may not feel sick. Do not stop taking this medication without consulting your doctor. Stopping anagrelide will cause your platelets to go back up.Your doctor will check your blood counts regularly to monitor your progress and adjust your dose.
SIDE EFFECTS: Headache, diarrhea, weakness, nausea, gas, loss of appetite, and dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: unusual bleeding/bruising, black stools, swelling of the ankles/feet, rapid/difficult breathing, stomach/abdominal pain, unusual tiredness, signs of kidney problems (such as change in the amount of urine, pink/bloody urine), vomit that looks like coffee grounds.Get medical help right away if you have any very serious side effects, including: chest/jaw/left arm pain, confusion/mental changes, severe dizziness, fainting, fast/irregular/pounding heartbeat, seizures, trouble speaking, vision changes, weakness on one side of the body.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking anagrelide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as heart attack, irregular heartbeat), lung problems, kidney problems, liver problems.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Anagrelide may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using anagrelide, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using anagrelide safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding is not recommended while using this medication and for 1 week after stopping this medication. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, "blood thinners" such as warfarin/enoxaparin), sucralfate.Only take aspirin if your doctor approves of it. Aspirin can increase the risk of bleeding when used with anagrelide, especially if you already have a high risk for bleeding. However, if your doctor has directed you to take low-dose aspirin to prevent blood clots, or for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Discuss the risks and benefits with your doctor or pharmacist.Many drugs besides anagrelide may affect the heart rhythm (QT prolongation), including amiodarone, chloroquine, clarithromycin, disopyramide, haloperidol, methadone, moxifloxacin, pimozide, procainamide, among others.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: unusual bleeding/bruising, fast heartbeat, vomiting.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as heart exam, EKG, complete blood counts, kidney/liver function) should be done before you start taking this medication and while you are taking it. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).
Information last revised May 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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