ANAGRELIDE HYDROCHLORIDE

ANAGRELIDE HYDROCHLORIDe
(a-na'gre-lyde)
Agrylin
Classifications: anticoagulant; antiplatelet agent;
Therapeutic: antiplatelet
; antithrombolytic
Pregnancy Category: C

Availability

0.5 mg, 1 mg capsules

Action

Anagrelide action appears to be related to a selective inhibition of platelet production. It inhibits platelet aggregation by affecting several aggregating agents (e.g., thrombin and arachidonic acid, ADP, and collagen).

Therapeutic Effect

Anagrelide is associated with significant decreases in platelet counts and is thought to prevent early changes in shape of platelets.

Uses

Essential thrombocythemia.

Unlabeled Uses

Polycythemia vera.

Contraindications

Hypotension, severe hepatic impairment, females of childbearing age; pregnancy (category C), lactation.

Cautious Use

Cardiovascular disease, renal and hepatic function impairment, jaundice. Safety and efficacy in patients <16 y are not established.

Route & Dosage

Essential Thrombocythemia
Adult (≥16 y): PO Start with 0.5 mg q.i.d. or 1 mg b.i.d. times 1 wk, may increase by 0.5 mg/d qwk until platelet count is <600,000/mcL (max: 10 mg/d)

Hepatic Impairment
0.5 mg q.d. for 1 wk

Administration

Oral
  • Make sure dosage increments do not exceed 0.5 mg/d in any 1 wk.
  • Store at 15°–25° C (59°–77° F) in a light-resistant container.

Adverse Effects (≥1%)

Body as a Whole: Asthenia, pain, edema (general), paresthesia, back pain, malaise, fever, chills, photosensitivity. CNS: Headache, dizziness, CVA, syncope, seizures. CV: Palpitations, chest pain, tachycardia, peripheral edema, CHF, MI, cardiomyopathy, heart block, atrial fibrillation, pericarditis, arrhythmia, hemorrhage. GI: Diarrhea, abdominal pain, nausea, flatulence, vomiting, dyspepsia, anorexia, pancreatitis, constipation, GI hemorrhage, and ulceration. Hematologic: Anemia, thrombocytopenia, ecchymoses, lymphedema. Respiratory: Dyspnea, pulmonary infiltrates, pulmonary fibrosis, pulmonary hypertension. Skin: Rash, urticaria. Other: Dysuria.

Pharmacokinetics

Absorption: 70% from GI tract. Food reduces bioavailability. Onset: 7–14 d. Duration: Increased platelet counts were observed 4 d after discontinuing drug. Metabolism: Extensively metabolized. Elimination: Primarily in urine as metabolites. Half-Life: 1.3–1.8 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for therapeutic effectiveness which is indicated by reduction of platelets for at least 4 wk to ≤600,000/mcL or 50% from baseline.
  • Monitor for S&S of CHF or myocardial ischemia.
  • Monitor for S&S of renal toxicity in patients with renal insufficiency (creatinine ≥2 mg/dL).
  • Monitor for S&S of hepatic toxicity in patients with liver functions >1.5 times upper limit of normal.
  • Lab tests: Monitor platelet count q2d for first wk, weekly thereafter until maintenance dose reached; closely monitor Hgb, WBC count, liver function tests, and BUN and creatinine while platelet count is being lowered.

Patient & Family Education

  • Contact physician if palpitations, fluid retention, breathing difficulty, or any other distressful symptoms develop.
  • Avoid excessive exposure to sunlight or UV light.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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