anagrelide hydrochloride

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.

Dosage adjustment

• 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.

Adverse reactions

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

Metabolic: dehydration

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

Patient monitoring

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.

Patient teaching

• 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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


(a-na-gre-lide) ,


(trade name)


Therapeutic: platelet reducing agent
Pregnancy Category: C


Treatment of thrombocythemia secondary to myeloproliferative disorders.


Decreases maturation of megakaryocytes (platelet precursors).

Therapeutic effects

Reduction in platelet count with reduced risk of complications associated with thrombocythemia (thrombosis).


Absorption: Well absorbed after oral administration.
Distribution: Unknown.
Metabolism and Excretion: Extensively metabolized; <1% excreted unchanged in urine.
Half-life: 1.3 hr.

Time/action profile (↓ in platelet count)

PO7–14 days4–12 wk4 days†
†Increase in platelet count after discontinuation


Contraindicated in: Hypersensitivity; Severe hepatic impairment; Lactation: Potential toxic effects in infant.
Use Cautiously in: Cardiovascular, renal or mild to moderate hepatic impairment (monitor closely during treatment); Obstetric / Pediatric: Has been used safely in pregnant women and children <16 yr.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (life-threatening)
  • dizziness (most frequent)
  • headache (most frequent)
  • malaise

Ear, Eye, Nose, Throat

  • abnormal vision


  • eosinophilic pneumonia (life-threatening)
  • interstitial pneumonitis (life-threatening)
  • pulmonary fibrosis (life-threatening)
  • pulmonary hypertension (life-threatening)
  • cough
  • dyspnea (most frequent)
  • pharyngitis


  • 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)
  • angina
  • atrial fibrillation
  • pericarditis
  • pericardial effusion
  • orthostatic hypotension
  • tachycardia


  • GI bleeding (life-threatening)
  • hepatotoxicity (life-threatening)
  • pancreatitis (life-threatening)
  • abdominal pain (most frequent)
  • diarrhea (most frequent)
  • flatulence (most frequent)
  • anorexia
  • constipation
  • dyspepsia
  • nausea
  • vomiting


  • renal failure (life-threatening)
  • dysuria
  • hematuria


  • alopecia
  • pruritis
  • rash


  • anemia


  • arthralgia
  • back pain
  • myalgia
  • weakness (most frequent)


  • paresthesia


  • fever


Drug-Drug interaction

Absorption 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.


Oral (Adults) 0.5 mg 4 times daily or 1 mg twice daily; may be ↑ weekly by 0.5 mg/day (not to exceed 10 mg/day or 2.5 mg as a single dose).
Oral (Children) 0.5 mg daily; may be ↑ weekly by 0.5 mg/day (not to exceed 10 mg/day or 2.5 mg as a single dose.

Hepatic Impairment

Oral (Adults) Initiate at 0.5 mg daily; may be ↑ weekly by 0.5 mg/day.

Availability (generic available)

Capsules: 0.5 mg, 1 mg

Nursing implications

Nursing assessment

  • 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 Diagnoses

Ineffective tissue perfusion (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)


  • Dose should be reduced to the lowest possible to maintain platelet count of <600,000/mcl. Most patients experience an adequate response at a dose of 1.5–3 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.

Patient/Family Teaching

  • 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.

Evaluation/Desired Outcomes

  • 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.
Drug Guide, © 2015 Farlex and Partners


A cytoreductive agent used to manage essential thrombocythaemia and thrombocythaemia due to myeloproliferative disorders (e.g., CML, polycythemia vera) to reduce platelets, risk of thrombosis and other symptoms. It is generally regarded as a second-line therapy compared to hydroxyurea.
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.


Anagrelide, see there.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
References in periodicals archive ?
The currently available immediate release formulation (Agrylin or anagrelide IR) is approved by the US FDA for the treatment of patients with thrombocythemia, secondary to myeloproliferative disorders, to reduce the elevated platelet count and the risk of thrombosis and to ameliorate associated symptoms including thrombo-hemorrhagic events.
The other drugs reviewed that also had no new safety concerns were anti-neoplastic agent Camptosar (irinotecan), antineoplastic agent Paraplatin (carboplatin), platelet-reducing agent Agrylin (anagrelide), and hematinic agent Ferrlecit (sodium ferric gluconate complex).
The other drugs reviewed that also had no new safety concerns were antineoplastic agent irinotecan (Camptosar), antineoplastic agent carboplatin (Paraplatin), platelet-reducing agent anagrelide (Agrylin), and hematinic agent sodium ferric gluconate complex (Ferrclecit).
Shire Pharmaceuticals Group plc (Nasdaq: SHPGY; LSE: SHP; TSX: SHQ), Basingstoke, England, has been signed an agreement with a leading haematology specialty company, the Pharmaceutical Division of Kirin Brewery Company Ltd, granting the rights to develop, register, formulate, package, label, market and sell AGRYLIN (anagrelide hydrochloride) in Japan, the world's second largest pharmaceuticals market.
The total potential value of the AGRYLIN deal is in excess of US$40 million including an upfront license fee of US$8 million, the payment of all development costs and the achievement of various development and sales milestones during the course of the agreement.
Total sales of AGRYLIN in 2002 were US$119.2 million, up 39% on 2001.
AGRYLIN is a treatment for essential thrombocythaemia (ET), a chronic disorder of bone marrow, which is associated with the increased production of blood platelets.
It is estimated that in Japan 4,000 patients suffer from ET and Polycythaemia Vera (PV), a related disorder which could be a target for treatment with AGRYLIN.
Sales of Shire's blood disorder treatment Agrylin rose 14 per cent in the quarter to pounds 19 million while its Reminyl drug achieved a 14.8 per cent share of the US Alzheimer's new prescription market after its launch.
In the first 6 months of 1997, the following new drugs were approved by the FDA: Agrylin, Alesse, Anzemet, Carbatrol, Fareston, Flomax, Galzin, Idamycin, Migranal, Posicor, Prelay, Prevacid, Pytest, Requip, Resulin, Serlect, Skelid, Tasmar, Uniretic, Urso, Vicoprofen, Viracept, Zyban.
WASHINGTON -- Several generic drug makers have received approval to market their versions of Agrylin. Shire Pharmaceuticals Group PLC manufactures the brand name product.
Besides its approval of a generic form of Agrylin, the company has been cleared to market a generic version of Kos Pharmaceutical Inc.'s Niaspan.