Agrylin, Xagrid (UK)
Pharmacologic class: Hematologic drug
Therapeutic class: Antiplatelet drug
Pregnancy risk category C
Unclear. May reduce platelet production by decreasing megakaryocytic hypermaturation, thereby decreasing platelet count and inhibiting platelet aggregation (at higher doses).
Capsules: 0.5 mg, 1 mg
⊘Indications and dosages
➣ Essential thrombocythemia
Adults: 0.5 mg P.O. q.i.d. or 1 mg P.O. b.i.d. for 1 week. Adjust as needed to lowest effective dosage that maintains platelet count below 600,000/mm3. Maximum dosage is 10 mg daily or 2.5 mg as a single dose.
• Hepatic or renal disease
• Prolonged exposure to sunlight
• Women who are or may become pregnant
Use cautiously in:
• renal, hepatic, or cardiac dysfunction
• pregnant or breastfeeding patients
• children younger than age 16.
• Give 1 hour before or 2 hours after meals.
CNS: amnesia, confusion, depression, dizziness, drowsiness, weakness, headache, syncope, insomnia, migraine, nervousness, pain, paresthesia, malaise, seizures, cerebrovascular accident
CV: angina, chest pain, hypertension, palpitations, orthostatic hypotension, peripheral edema, vasodilation, arrhythmias, tachycardia, heart failure, hemorrhage, myocardial infarction, cardiomyopathy, cardiomegaly, atrial fibrillation, complete heart block, pericarditis
EENT: amblyopia, abnormal or double vision, visual field abnormalities, tinnitus, epistaxis, rhinitis, sinusitis
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, melena, gastric or duodenal ulcers, dyspepsia, aphthous stomatitis, anorexia, flatulence, gastritis, pancreatitis, GI hemorrhage
GU: painful urination, hematuria
Hematologic: lymphadenoma, bleeding tendency, anemia, thrombocytopenia
Musculoskeletal: leg cramps; joint, back, muscle, neck pain
Respiratory: bronchitis, dyspnea, pneumonia, respiratory disease, asthma, pulmonary infiltrates, pulmonary fibrosis, pulmonary hypertension
Skin: bruising, pruritus, rash, alopecia, urticaria, skin disease, photosensitivity reaction
Other: chills, fever, flulike symptoms, edema
Drug-drug.Sucralfate: interference with anagrelide absorption
Drug-diagnostic tests.Hemoglobin, platelets: decreased values
Hepatic enzymes: elevated values
Drug-food.Any food: decreased drug bioavailability
Drug-herbs.Evening primrose oil, feverfew, garlic, ginger, ginkgo biloba, ginseng, grapeseed: increased antiplatelet effect
☞ Watch for signs and symptoms of vasodilation, heart failure, and arrhythmias in patients with cardiovascular disease.
• For first 2 weeks, monitor CBC and liver and kidney function test results.
• Monitor platelet count regularly until maintenance dosage is established.
• Check regularly for adverse reactions, especially bleeding tendency.
• Monitor blood pressure for orthostatic hypertension.
• Instruct patient to take drug 1 hour before or 2 hours after meals.
• Tell patient that drug may cause a temporary blood pressure decrease if he sits or stands up suddenly. Tell him to rise slowly and carefully.
☞ Instruct patient to report unusual bleeding or bruising or difficulty breathing.
☞ Tell patient to avoid prolonged exposure to sunlight.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and vision.
• Inform patient using hormonal contraceptives that drug may interfere with contraceptive efficacy. Advise her to use alternative birth control method.
• Tell patient to avoid activities that may cause injury. Tell him to use soft toothbrush and electric razor to avoid gum and skin injury.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Notify patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.
ClassificationTherapeutic: platelet reducing agent
Time/action profile (↓ in platelet count)
|PO||7–14 days||4–12 wk||4 days†|
Adverse Reactions/Side Effects
Central nervous system
- seizures (life-threatening)
- dizziness (most frequent)
- headache (most frequent)
Ear, Eye, Nose, Throat
- abnormal vision
- eosinophilic pneumonia (life-threatening)
- interstitial pneumonitis (life-threatening)
- pulmonary fibrosis (life-threatening)
- pulmonary hypertension (life-threatening)
- dyspnea (most frequent)
- cerebrovascular accident (life-threatening)
- complete heart block (life-threatening)
- HF (life-threatening)
- MI (life-threatening)
- torsade de pointes (life-threatening)
- ventricular tachycardia (life-threatening)
- chest pain (most frequent)
- edema (most frequent)
- palpitations (most frequent)
- atrial fibrillation
- pericardial effusion
- orthostatic hypotension
- GI bleeding (life-threatening)
- hepatotoxicity (life-threatening)
- pancreatitis (life-threatening)
- abdominal pain (most frequent)
- diarrhea (most frequent)
- flatulence (most frequent)
- renal failure (life-threatening)
- back pain
- weakness (most frequent)
Drug-Drug interactionAbsorption may be ↓ by sucralfate.Fluvoxamine may ↑ blood levels.May ↑ blood levels of theophylline.May ↑ effects of milrinone and cilostazol.Concurrent use with aspirin may ↑ risk of bleeding.
Hepatic ImpairmentOral (Adults) Initiate at 0.5 mg daily; may be ↑ weekly by 0.5 mg/day.
Availability (generic available)
- Monitor BP during initial therapy and periodically thereafter. May cause hypotension, especially upon standing.
- Assess cardiovascular status and obtain at ECG before initiation of therapy and periodically during therapy. May cause vasodilation, tachycardia, palpitations, and heart failure. Close cardiovascular monitoring is required for patients with moderate hepatic impairment.
- Monitor for signs and symptoms of interstitial lung diseases (progressive dyspnea with lung infiltrations). May occur from 1 week to several years after initiating anagrelide. Symptoms usually improve after discontinuation of anagrelide.
- Lab Test Considerations: Monitor platelet count every 2 days during first wk of therapy and weekly until maintenance dose is reached. Platelet count usually begins to drop within 7–14 days.
- Monitor AST and ALT prior to and periodically during therapy.
- Monitor hemoglobin, WBC, BUN, and serum creatinine during the first 2 wk of therapy.
Potential Nursing DiagnosesIneffective tissue perfusion (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- Dose should be reduced to the lowest possible to maintain platelet count of <600,000/mcl. Most patients experience an adequate response at a dose of 1.5–3 mg/day.
- Interruption of therapy is usually followed by an increase in platelet count within 4 days.
- Oral: May be taken without regard to food.
- Instruct patient to take medication as directed.
- May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Caution patient to stand slowly.
- Instruct patient to limit alcohol intake as it may worsen the side effects of anagrelide.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Advise patient to use contraception during therapy and to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. May cause fetal harm.
- Maintenance of platelet count at <600,000/mcl or decrease of ≥50% from baseline. Initial response is expected in 7–14 days with complete response in 4–12 wks.