anagrelide (Rx)

Brand and Other Names:Agrylin
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Dosing & Uses

AdultPediatric

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
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Interactions

Interaction Checker

and anagrelide

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            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 (134)

            • 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.

            • 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 (56)

            • 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.

            • 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.

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            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

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            Warnings

            Contraindications

            Severe hepatic impairment

            Cautions

            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

            Coadministration with aspirin increases risk for major hemorrhagic event

            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 highoutput heart failure by PDE4 inhibition (may be reversible upon discontinuation)

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            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.

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            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%)

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            anagrelide oral
            -
            0.5 mg capsule
            anagrelide oral
            -
            1 mg capsule
            anagrelide oral
            -
            1 mg capsule
            Agrylin oral
            -
            0.5 mg capsule

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            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 that you are using this medication.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.Laboratory and/or medical tests (such as heart exam, EKG, complete blood counts, kidney and liver function tests) should be performed before you start treatment, periodically to monitor your progress, or to check for side effects. 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 2022. Copyright(c) 2022 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.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.