Anagrelide

How it works

It selectively inhibits megakaryocyte maturation and proliferation, reducing platelet production; it also has phosphodiesterase III inhibitory and vasodilator activity.

Prescribing in practice

• Its positive inotropic and vasodilator effects can cause palpitations, tachycardia and fluid retention, so it is used with caution and cardiovascular assessment in those with known or suspected heart disease.
• Dose is titrated against the platelet count under specialist haematology supervision to the lowest level that maintains control.
• Headache, diarrhoea and fluid retention are common early adverse effects that often settle with continued treatment.

Monitoring

Monitor the full blood count regularly during titration and maintenance, with baseline and periodic cardiac assessment as clinically indicated.

Counselling the patient

• Report palpitations, breathlessness, chest pain or ankle swelling promptly.
• Do not stop suddenly without advice, as the platelet count can rebound.

Evidence & guidelines

Use is supported by haematology guidance and the SPC as a cytoreductive option in high-risk essential thrombocythaemia, particularly where hydroxycarbamide is unsuitable.