Home Drug Guide Anagrelide Hydrochloride

Drug Guide

Generic Name

Anagrelide Hydrochloride

Brand Names Agrylin

Classification

Therapeutic: Antiplatelet agent / Hematologic agent

Pharmacological: Phosphodiesterase III inhibitor

FDA Approved Indications

Essential thrombocythemia (to reduce elevated platelet counts)

Mechanism of Action

Inhibits phosphodiesterase III, leading to increased cyclic AMP levels in platelets, which decreases platelet production and aggregation.

Dosage and Administration

Adult: Start at 1 mg four times daily; titrate based on response and tolerability, up to a maximum dose of 10 mg/day.

Pediatric: Not generally recommended; data limited.

Geriatric: Use with caution, starting at lower doses due to increased risk of adverse effects.

Renal Impairment: Adjust dose based on clinical response and tolerability.

Hepatic Impairment: Use with caution; no specific dosing adjustment established.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; crosses blood-brain barrier.

Metabolism: Metabolized mainly in the liver via CYP450 enzymes.

Excretion: Primarily via urine; small amount via feces.

Half Life: Approximately 1-2 hours.

Contraindications

Myocardial infarction within 6 months
Uncontrolled arrhythmias
Severe heart failure

Precautions

History of cardiac arrhythmias
Thrombocytopenia
Liver impairment
Concurrent use with other PDE inhibitors

Adverse Reactions - Common

Headache (Common)
Tachycardia (Common)
Fluid retention (Common)
Feeling anxious or nervous (Common)

Adverse Reactions - Serious

Heart failure or worsening cardiac function (Serious but rare)
Arrhythmias, including ventricular arrhythmias (Serious but rare)
Thromboembolism (Serious but rare)
Severe hypotension or hypertension (Serious but rare)

Drug-Drug Interactions

Other medications affecting cardiac rhythm or blood pressure, CYP450 inhibitors or inducers.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood count, platelets, and cardiac status regularly.

Diagnoses:

Risk for bleeding due to thrombocytopenia or adverse effects.
Risk for cardiovascular issues.

Implementation: Administer as prescribed, monitor vital signs, blood counts, and cardiac function, educate patient about symptoms of cardiac dysfunction.

Evaluation: Assess effectiveness in reducing platelet counts and monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Report chest pain, palpitations, or adverse symptoms immediately.
Avoid abrupt discontinuation.
Attend regular blood tests and follow-up.

Special Considerations

Black Box Warnings:

Potential for hematologic and cardiovascular side effects; monitor closely.

Genetic Factors: CYP450 polymorphisms may affect metabolism.

Lab Test Interference: May alter bone marrow and blood counts.

Overdose Management

Signs/Symptoms: Severe hypotension, tachyarrhythmias, chest pain, syncope.

Treatment: Discontinue drug immediately, provide supportive care, consider symptomatic treatments such as IV fluids, vasopressors, or antiarrhythmics as needed.

Storage and Handling

Storage: Store at room temperature away from moisture, light, and heat.

Stability: Stable when stored properly, check expiration date.