Anagrelide

How it works

It selectively inhibits the maturation of megakaryocytes, reducing platelet production; it also has phosphodiesterase III inhibitory and platelet-aggregation-inhibiting effects.

Prescribing in practice

• It can cause cardiac effects including palpitations, tachycardia and rarely cardiac failure, so assess cardiovascular status before and during treatment.
• Dose is titrated against the platelet response, and abrupt withdrawal may cause a rebound rise in platelets.
• Headache, fluid retention and gastrointestinal upset are common, especially early in treatment.

Monitoring

Monitor the platelet count closely during titration and maintenance, with periodic review of cardiac and renal function.

Counselling the patient

• Report palpitations, breathlessness or swelling of the ankles.
• Do not stop the medicine suddenly without medical advice.
• Headache is common at first and usually settles as treatment continues.

Evidence & guidelines

Anagrelide is an established platelet-lowering option in essential thrombocythaemia, used according to risk and tolerance of alternative cytoreductive therapy.