Drug interactions-

CYP1A2 inhibitors eg theophylline + Analgrelide-
anagrelide demonstrates some limited inhibitory activity towards CYP1A2 which may present for
interaction with other coadministered medications sharing the same clearance mechanism

Sucrafate + Analgrelide -
a single report suggest that sucralfate may interfere with analgrelide absorption

Analgrelide + Aspirin-
 anagrelide enhanced the inhibition of platelet aggregation with aspirin

Analgrelide + cyclic AMP PDE III  eg milirone, enoximone, amiranone, olprinone, clilostazol-
 anagrelide is an inhibitor of cyclic AMP PDE III. The effects of medicinal products with similar
properties may be exacerbated by analgrelide

Thrombocytopenia

Adverse reactions 5% and more-

Cardiovascular-      palpitations 26%    tachycardia  7%

CNS-                        headache  43%     asthenia  23%     dizziness 15%     paresthesia 5%

Dermatologic-         rash, including urticaria  8%  pruritus 5%

GI -                           diarrhea  25%    nausea  17%   abdominal pain  16%   flatulence 10%
                                  vomiting 9%      anorexia  7%    dyspepsia  5%

Adverse reactions less than 5%-

Cardiovascular -       angina pectoris,  arrhyhthmias,   cardiovascular disease, heart failure

CNS-    amnesia , confusion,  depression,  insomnia, migraine, nervousness, somnolence

Dermatologic-   alopecia, skin disease

GI -                    apothous stomatitis, constipation, eructations, gastritis, GI distress

GU-                  dysuria, hematuria

Hematologic/lymphatic -  anemia, errchymosis,  lymphadenopathy, thrombocytopenia

Hepatic -        elevated liver enzyme,

Musculoskeletal-     atharlgia, leg cramps, myalgia

Respiratory-            asthma, bronchitis, epistaxis, pneumonia, respiratory disease, rhinitis,

Special senses-        abnormal vision, amblyopia, diplopia, tinnitus, visual field abnormality

Miscellaneous-           chills, dehydration, flu symptoms, hemorrhage, photosensitivity     

Severe hepatic impairment

Special Precautions-

Cardiovascular- use anagrelide with caution in patients with known or suspected heart disease,
and only if the potential benefit outweigh the potential risk. 
Therapeutic doses of analgrelide may cause cardiovascular  effects including vasodilation,
tachycardia, palpitations, and congestive heart failure.

Cesstion of treatment-  after sudden stoppage of analgrelide therapy, the increase in platelet
count can be observed within 4 days.

Hepatic function impairment-  assess the potential risks and benefits in a patient with mild to
moderate hepatic impairment,  before treatment begins. In such patients dose reduction is
required. Carefully monitor patients with cardiovascular effects.

Pregnancy- instruct patients of child bearing age that they should use contraception while taking
analgrelide. Anagrelide may cause fetal harm when administered to a pregnant women.

Lactation- decide whether to discontinue breast feeding or the drug depending on the importance
of the drug to the mother

Children- no overall difference in dosing and safety were observed between pediatric and adult
patients.

Monitoring- monitor platelet count, blood counts, hemoglobin, blood counts, white cells counts,
liver function tests AST, ALT and renal function ( serum creatinine, serum urea nitrogen BUN.
Platelet counts should be performed every 2 days, during the first week of treatment and at least
weekly, thereafter until the maintenance dosing is reached

Indication-
Thrombocytopenia

Dosage-
Recommended starting dose- for adults- 0.5mg 4 times daily or 1mg  2 times daily, which should be
maintained for at least 1 week.

Starting dose in pediatric patients have ranged from 0.5mg/day to 0.5mg 4 times daily
An initial starting dose of 0.5mg/day is recommended

Pharmacology-
The mechanism by which analgrelide reduces blood platelet count is still under investigation. Studies
support  a hypothesis of dose related reduction in the platelet reduction resulting from a decrease in
megakaryocyte hypermaturation

Pregnancy-
 Instruct patients of child bearing age that they should use contraception while taking
anagrelide. Anagrelide may cause fetal harm when administered to a pregnant women.

Lactation-
Decide whether to discontinue breast feeding or the drug depending on the importance
of the druug to the mother

Children-
No overall difference in dosing and safety were observed between pediatric and adult
patients.