Anagrelide
Pronunciation: pronunciation varies by local usage.
- Generic name
- anagrelide
- Brand names
- Agrylin, Xagrid
- Drug class
- Platelet-lowering agent (phosphodiesterase 3 inhibitor)
- Form
- Capsules
- Route
- Oral
- Legal status
- Prescription-only medicine
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
What anagrelide is and how it works
Anagrelide is a platelet-lowering medicine that reduces elevated platelet count and the risk of thrombosis in people with thrombocythemia secondary to myeloproliferative neoplasms. (1)
It is a specialist-prescribed treatment; doses are adjusted based on regular blood tests and electrocardiograms (ECGs). The medicine is taken as capsules.
Mechanism of action: how anagrelide works
Anagrelide is a phosphodiesterase 3 (PDE3) inhibitor that reduces platelet production, likely through effects on megakaryocyte maturation, thereby lowering platelet count in myeloproliferative disorders. (1)
What anagrelide is used for
Thrombocythemia secondary to myeloproliferative neoplasms
Anagrelide reduces elevated platelet count and the risk of thrombosis in adults and children with thrombocythemia secondary to myeloproliferative neoplasms. Dosing is individualised by a specialist. (1)
Before taking anagrelide
Do not take / not appropriate for
- Do not take anagrelide if you have severe liver impairment, unless your specialist determines otherwise. (all indications) (1)
- Do not breastfeed while taking anagrelide and for one week after the final dose. (all indications) (1)
Tell your clinician about
- All heart conditions, including heart rhythm problems (QT prolongation), heart failure, or a history of palpitations, fainting, or chest pain.
- Any lung problems, especially new or worsening shortness of breath, or known pulmonary hypertension or interstitial lung disease.
- Liver or kidney problems.
- Bleeding disorders or if you are taking aspirin, anticoagulants, or other medicines that affect clotting.
- Pregnancy, plans for pregnancy, or breastfeeding status.
- All other medicines and supplements you take, particularly fluvoxamine, ciprofloxacin, cilostazol, milrinone, or any medicines known to affect heart rhythm (QT-prolonging drugs).
How to take anagrelide
- Anagrelide is taken by mouth, typically starting at 0.5 mg four times a day or 1 mg twice a day for adults, and 0.5 mg once a day for children. The starting dose is held for at least one week.
- The specialist adjusts the dose gradually (not more than 0.5 mg per day each week) based on platelet counts. The goal is to bring platelet levels below 600,000 per microliter, ideally into the 150,000–400,000/µL range.
- Do not exceed a total of 10 mg per day or take more than 2.5 mg in a single dose.
- Do not change your dose or stop taking anagrelide without your prescriber’s instructions.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
If you miss a dose, contact your prescriber for advice. Do not take two doses at once to make up for a missed one.
Overdose
If you suspect an overdose, contact your prescriber or seek emergency medical attention immediately. Overdose may increase the risk of serious side effects such as abnormal heart rhythms or bleeding. (1)
Side effects
Many people experience side effects, especially when starting treatment. The most common ones are headache, palpitations, diarrhea, weakness, fluid retention, nausea, abdominal pain, and dizziness.
Headache
What to notice: Frequent or severe headache (reported in 44% of patients).
What to do: Tell your prescriber if headaches are persistent or bothersome. (1)
Palpitations
What to notice: Feeling your heart racing, pounding, or fluttering (reported in 26%).
What to do: Inform your prescriber, especially if accompanied by dizziness, chest pain, or fainting. (1)
Diarrhea
What to notice: Loose or frequent stools (reported in 26%).
What to do: Stay hydrated. Discuss with your prescriber if severe or persistent. (1)
Fluid retention (edema)
What to notice: Swelling of legs, ankles, feet, or hands (reported in 21%).
What to do: Tell your prescriber, especially if swelling is rapid or worsening. (1)
Nausea or abdominal pain
What to notice: Stomach upset, pain, or discomfort (nausea 17%, abdominal pain 16%).
What to do: Speak to your prescriber if these symptoms are troublesome. (1)
Possible heart rhythm problem
What to notice: Severe palpitations, fainting, dizziness, or chest pain.
What to do: Seek immediate medical attention, as these could indicate a dangerous heart rhythm. (1)
Worsening breathlessness or signs of heart/lung disease
What to notice: New or worse shortness of breath, persistent cough, chest discomfort, or swelling.
What to do: Contact your prescriber promptly for evaluation. (1)
Unusual bleeding or bruising
What to notice: Easy bruising, bleeding gums, blood in stool or urine, or prolonged bleeding from cuts.
What to do: Inform your prescriber immediately, especially if you are also taking aspirin or anticoagulants. (1)
Serious warnings
QT prolongation and serious heart rhythm disorders — emergency
Symptoms: Heart palpitations, fainting, severe dizziness, chest pain, or sudden cardiac arrest.
Action: Seek emergency medical care immediately. A pre-treatment ECG is essential, and other QT-prolonging drugs must be avoided. (1)
Heart failure — serious
Symptoms: Shortness of breath, swelling, fatigue, trouble lying flat, rapid weight gain.
Action: Contact your prescriber urgently; anagrelide may worsen heart failure, particularly in severe cases. (1)
Pulmonary hypertension — serious
Symptoms: Progressive breathlessness, chest pain, fatigue, dizziness, or fainting.
Action: Report these symptoms to your prescriber immediately; a cardiopulmonary evaluation may be needed. (1)
Interstitial lung disease — serious
Symptoms: Worsening breathlessness, dry cough, or new lung infiltrates on imaging.
Action: Seek medical assessment promptly; anagrelide may need to be stopped under specialist guidance. (1)
Increased bleeding risk with aspirin — serious
Symptoms: Unusual bleeding, including gastrointestinal or other major hemorrhages.
Action: The prescriber must assess the risk before combining anagrelide with aspirin; bleeding symptoms require immediate medical review. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin) | These drugs can increase the amount of anagrelide in your body, potentially increasing side effects. | Your prescriber may need to adjust your anagrelide dose. Tell your prescriber if you are taking any of these medicines. (1) |
| Aspirin and anticoagulants | Combined use increases the risk of major bleeding events. | The prescriber will weigh the risks and benefits; do not start or stop aspirin without medical advice. (1) |
| Other phosphodiesterase 3 (PDE3) inhibitors (e.g., cilostazol, milrinone) | Additive effects on the heart and blood vessels; this combination should be avoided. | Inform your prescriber if you are taking any of these medicines; an alternative may be needed. (1) |
| QT-prolonging drugs (e.g., certain antiarrhythmics, antipsychotics, antibiotics) | Increased risk of dangerous heart rhythm abnormalities. | Avoid these combinations; your prescriber should review your full medication list before starting anagrelide. (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Children and adolescents
The US label includes a starting dose of 0.5 mg once daily for children. Dosing is otherwise similar to adults, with titration based on platelet counts and tolerability. Specialist management is required. (1)
Pregnancy
Limited human data are available; animal studies showed developmental delays at high doses. The decision to use anagrelide during pregnancy must be made by the specialist, weighing potential risk against the need for platelet control. (1)
Breastfeeding
The manufacturer advises not to breastfeed during treatment and for one week after the final dose. Discuss with your specialist if breastfeeding is planned. (1)
Hepatic impairment
In moderate liver impairment, the starting dose is reduced to 0.5 mg per day. Anagrelide should be avoided in severe hepatic impairment. Specialist guidance is essential. (1)
Monitoring
Before starting
- Obtain a cardiovascular examination and electrocardiogram (ECG) to assess for QT prolongation and other heart disorders.
- Check baseline complete blood count (CBC), hepatic enzymes, renal function, and electrolytes.
- Confirm the diagnosis of thrombocythemia secondary to myeloproliferative neoplasms and exclude other causes of elevated platelets.
During treatment
- Monitor platelet counts every two days during the first week, then at least weekly until the maintenance dose is established.
- Periodically reassess CBC, liver and kidney function, and electrolytes.
- Repeat ECGs periodically and if any heart symptoms develop.
- Watch for signs of heart failure, pulmonary hypertension, interstitial lung disease, and unusual bleeding.
- Do not attempt dose adjustments without specialist guidance based on platelet counts.
Storage
Store at 25°C (excursions allowed between 15–30°C) in a light-resistant container. Keep out of reach of children.
Professional information
Clinician-facing context only. Always consult the current local prescribing information and relevant guidelines.
All regions
Indication: Thrombocythemia secondary to myeloproliferative neoplasms
Dose summary: Adults: start 0.5 mg four times daily or 1 mg twice daily. Children: start 0.5 mg once daily. Maintain starting dose for ≥1 week, then titrate weekly by ≤0.5 mg/day increments to target platelet count <600,000/µL (ideal 150,000–400,000/µL). Maximum: 10 mg/day and 2.5 mg/dose. Moderate hepatic impairment: start 0.5 mg/day. Severe hepatic impairment: avoid.
Renal context: No specific dose adjustment for renal impairment is provided in the US label; assess individually. (1)
Hepatic guidance
In moderate hepatic impairment (Child-Pugh B), start 0.5 mg once daily. Avoid use in severe hepatic impairment (Child-Pugh C).
Overdose note
Overdose may cause exaggerated pharmacologic effects including bleeding and arrhythmias; management is supportive, and specialist advice should be sought. (1)
Frequently asked questions
Is Xagrid the same as Agrylin?
Yes. Anagrelide is sold under the brand name Agrylin in the United States and as Xagrid in Europe. They contain the same active ingredient. (1)
Why do I need so many blood tests when starting anagrelide?
Your platelet counts are checked every two days in the first week, then weekly during dose adjustments, because the dose is carefully increased to bring your platelet level into a safe range (ideally 150,000–400,000/µL). (1)
Why did my doctor order an ECG before I start anagrelide?
Anagrelide can affect the heart’s electrical activity (QT prolongation) and cause palpitations. A baseline ECG and periodic checks help your specialist monitor your heart safely during treatment. (1)
Can I take aspirin with anagrelide?
Combining anagrelide with aspirin has been associated with an increased risk of major bleeding. Your specialist will decide whether the combination is appropriate for you based on your individual risk factors. (1)
What symptoms should prompt me to seek help urgently?
Seek immediate medical attention if you experience palpitations with faintness, chest pain, worsening shortness of breath (which could signal heart or lung problems), or unusual bleeding or bruising. (1)
What is the mechanism of action of anagrelide?
Anagrelide is a phosphodiesterase 3 (PDE3) inhibitor that reduces platelet production, likely through effects on megakaryocyte maturation, thereby lowering platelet count in myeloproliferative disorders. (1)
What is the generic name of Anagrelide?
The generic name is anagrelide. It is sold under brand names including Agrylin, Xagrid. (1)
What class of drug is anagrelide?
Anagrelide is classed as: Platelet-lowering agent (phosphodiesterase 3 inhibitor). (1)
References
- AGRYLIN (anagrelide hydrochloride) capsules, for oral useU.S. Food and Drug Administration (via DailyMed) · United States · dated 2024-10 · accessed 2026-08-08 · source 1
- ANAGRELIDE CAPSULE [ANI PHARMACEUTICALS, INC.] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 2
- Anagrelide — FDA approval record (Drugs@FDA ANDA076811)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 3
- anagrelide — RxNorm normalized drug concept (RXCUI 236612)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 4
Brand names by country
Single-ingredient anagrelide names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Agrylin.5 mg · takeda pharmaceuticals america, inc.
Canada
- AGRYLIN