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Platelet Reducing Agent (Specialist Drug)

Anagrelide

Brand names: Xagrid

Adult dose

Dose: Initially 500 micrograms twice daily (or 4 times daily); increase by no more than 500 micrograms/day per week; usual range 1–3 mg/day; max 10 mg/day
Route: Oral
Frequency: Initially twice daily; adjusted based on response and tolerability

Clinical pearls

  • Indicated for essential thrombocythaemia (ET) — reduces platelet count in at-risk patients
  • NICE TA228 (2010): anagrelide as second-line option in ET when other treatments inadequate
  • PT-1 trial: hydroxyurea superior to anagrelide for ET in first line (higher arterial thrombosis and myelofibrotic transformation with anagrelide); but anagrelide may be preferred for venous thrombosis risk profile
  • Inhibits megakaryocyte maturation (reduces platelet production); also inhibits platelet aggregation at lower doses
  • Does NOT reduce WBC or RBC (unlike hydroxyurea) — useful if cytopenia of other lines
  • Target platelet count: <400–600 × 10⁹/L typically

Contraindications

  • Severe hepatic impairment
  • Severe renal impairment (eGFR <50 — limited data)
  • Moderate to severe cardiac disease (if not carefully managed)

Side effects

  • Palpitations, tachycardia (very common — vasodilatory and positive inotropic effects)
  • Headache
  • Fluid retention/oedema
  • Diarrhoea, nausea
  • Anaemia
  • Cardiac failure (rare but serious)
  • Pulmonary hypertension (rare)

Interactions

  • Sucralfate — reduces anagrelide absorption
  • Antiplatelet agents — additive antiplatelet effect
  • QT-prolonging drugs — additive risk
  • Fluvoxamine, other CYP1A2 inhibitors — may increase anagrelide levels

Monitoring

  • Full blood count (especially platelets) — every 2 weeks until stable, then monthly
  • LFTs and renal function at baseline and periodically
  • ECG at baseline (QTc) and after dose changes
  • Echocardiogram — recommended at baseline (pulmonary hypertension, cardiac function)

Reference: BNF; NICE TA228 (Anagrelide for essential thrombocythaemia, 2010); PT-1 trial (NEJM 2005); BSH Guidelines on ET (2010 updated); https://bnf.nice.org.uk/drugs/anagrelide/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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