ANAGRELIDE 0.5MG CAPSULES 100`S

Anagrelide is a medicine that reduces the number of platelets (blood cells involved in clotting) in the bloodstream. It works by inhibiting megakaryocyte maturation — blocking the development of the bone marrow cells that produce platelets. This reduces the risk of thrombotic (clotting) and haemorrhagic (bleeding) complications seen when platelet counts are dangerously high.

Anagrelide 0.5 mg is indicated for: Essential Thrombocythaemia (ET) — a rare bone marrow disorder causing overproduction of platelets, when first-line cytoreductive therapy is not appropriate or has failed; Some cases of other myeloproliferative disorders with thrombocytosis in high-risk patients.

Anagrelide is typically reserved for high-risk ET patients (age >60, history of thrombosis, very high platelet count >1500 × 10⁹/L, or cardiovascular risk factors).

The starting dose is 0.5 mg four times daily or 1 mg twice daily, taken for at least 1 week before any adjustment.

•       Usual starting dose: 0.5 mg 4 times daily (or 1 mg twice daily).

•       Dose titration: Increase by no more than 0.5 mg/day each week until platelet count falls to <600 × 10⁹/L (ideally to the normal range).

•       Usual maintenance dose: 1–3 mg/day in divided doses.

•       Maximum dose: 10 mg/day or 2.5 mg as a single dose.

Take with or without food. Capsules should be swallowed whole. Consistent timing is important — take at the same times each day.

Common Side Effects (particularly at treatment initiation)

•       Headache — often mild and occurs early; usually improves with continued treatment.

•       Palpitations and increased heart rate (tachycardia) — especially in the first days of treatment.

•       Fluid retention and oedema — ankle swelling.

•       Diarrhoea, nausea, abdominal pain.

•       Dizziness, fatigue.

Serious Side Effects — Report Immediately

•       Cardiac effects: chest pain, shortness of breath, severe palpitations — anagrelide can worsen heart failure and cause cardiomegaly (enlarged heart).

•       Anaemia: pallor, extreme fatigue, shortness of breath.

•       Pulmonary hypertension: breathlessness, fatigue, leg swelling.

•       Severe headache that is persistent or worsening.

•       Thrombotic events (blood clots) — despite treatment, if platelet count control is inadequate.

Cardiac Monitoring Essential

Anagrelide has positive chronotropic and inotropic cardiac effects (increases heart rate and force of contraction) which can worsen pre-existing heart disease. An ECG and echocardiogram are recommended before starting treatment and periodically thereafter.

Pregnancy

Anagrelide must not be used during pregnancy. Women of childbearing potential must use effective contraception during treatment. Animal studies show harmful effects on foetal development. If pregnancy occurs during treatment, stop anagrelide immediately and discuss alternative management with your haematologist.

Platelet Monitoring

Regular full blood count (FBC) including platelet count monitoring is essential to guide dose adjustments. The goal is to normalise platelet count (typically <400–600 × 10⁹/L) without causing thrombocytopenia (dangerously low platelet count <100 × 10⁹/L).

•       Other phosphodiesterase III inhibitors (e.g., milrinone, cilostazol) — additive platelet-inhibiting effects; avoid combination.

•       Anticoagulants and antiplatelet agents (aspirin, clopidogrel, warfarin, heparin) — increased bleeding risk; use with caution.

•       Sucralfate — may reduce absorption of anagrelide; take at different times.

•       Foods/medicines affecting CYP1A2 (e.g., fluvoxamine, ciprofloxacin) — may increase anagrelide levels.

•       QT-prolonging medicines — additive risk of cardiac arrhythmia.

•       Store below 25°C, in a dry place, away from light.

•       Keep in the original packaging.

•       Keep out of reach of children.

Anagrelide is a prescription-only medicine (POM) in Kenya. It must only be initiated and supervised by a haematologist or specialist physician experienced in the management of myeloproliferative disorders.

•       Monitor FBC (including platelets) every 2 weeks until stable, then monthly.

•       Baseline and periodic: ECG, echocardiogram (cardiac function), LFTs, renal function.

•       Hepatic impairment: Mild (Child-Pugh A): use with caution and halve starting dose. Moderate-severe: contraindicated.

•       Renal impairment: CrCl 30–59 mL/min: use with caution. <30 mL/min: contraindicated.

•       Target platelet count: <600 × 10⁹/L (some guidelines target normal range <400 × 10⁹/L).

•       Compared to hydroxyurea: anagrelide is platelet-selective (does not reduce WBC or RBC) but has more cardiovascular side effects; hydroxyurea preferred as first-line in most guidelines.

Why do I feel palpitations when I start anagrelide?

Anagrelide affects the heart muscle directly, increasing the heart rate and force of contraction — especially in the first days of treatment. These palpitations are common and usually decrease over time. However, always report severe palpitations or chest pain immediately.

How long will I need to take anagrelide?

Anagrelide is typically a long-term treatment. Essential thrombocythaemia is a chronic condition, and anagrelide controls (but does not cure) the platelet overproduction. Treatment duration is guided by your haematologist.

Will anagrelide affect my other blood cells?

Anagrelide is platelet-selective. Unlike hydroxyurea, it does not significantly reduce red blood cells or white blood cells. However, anaemia can still occur in some patients.

Can I take aspirin with anagrelide?

Low-dose aspirin is sometimes co-prescribed with anagrelide for high-risk ET patients. However, combining anagrelide with aspirin increases bleeding risk and should only be done under specialist guidance with careful monitoring.

Is anagrelide safe during pregnancy?

No — anagrelide must not be taken during pregnancy. Women of childbearing age must use effective contraception during treatment. If pregnancy is planned, discuss safe alternative treatments (e.g., interferon-alpha) with your haematologist before stopping anagrelide.