How it works
The way anagrelide works is not fully understood, but we do know that this drug lowers the platelet count by reducing production of the platelet-producing cells called megakaryocytes. Anagrelide has the advantage over other therapies in that it will only reduce the platelet count. This means that red and white blood cells will not be affected.
Why take this drug
Anagrelide works by slowing the production of blood cells in your bone marrow. Most people tolerate anagrelide very well and do not have many side effects. If you do not tolerate hydroxycarbamide well, your haematologist may suggest that you try anagrelide as an alternative. If you have taken hydroxycarbamide for many years, your MPN may become resistant to this treatment, or you may develop long-term side effects. Your haematologist may suggest that you switch to anagrelide if this happens.
A trial in Europe called the PT1 trial suggested that anagrelide may not be as good as hydroxycarbamide in preventing clotting and bleeding complications in ET. Some research also appears to show that anagrelide is not as good as hydroxycarbamide at reducing transformation to myelofibrosis. Other studies have not always shown this trend, the Anahydret study did not, but the EXELS study did. This suggests that the effect may not be strong. In Europe anagrelide is recommended as a second-line treatment. Patients taking anagrelide should be monitored for the development of MF.
Anagrelide is not a chemotherapy drug; however, some hospitals classify anagrelide as a form of chemotherapy because it interferes with cell development, and the prescribing regulations are similar to those governing a chemotherapy drug. For this reason patients may be asked to sign a consent to treatment form before starting the drug for the first time.
Common side effects
Anagrelide can have side effects including headaches, diarrhoea, palpitations and fluid retention.
This drug is not suitable for use in pregnancy, and must be used with caution in the case of patients with heart disease.
Can I eat and drink normally? Yes. We recommend that you eat a normal, healthy diet and drink plenty of water.
Can I drink alcohol? While it is safe to drink alcohol in moderation whilst taking anagrelide, we recommend you do not exceed the recommended weekly limits of 14 units of alcohol per week for men and women. Alcohol can cause dehydration, and it is important to avoid becoming dehydrated if you have an MPN. Please ask your nurse or doctor if you require more information regarding alcohol consumption.
What if I want to have a child? We recommend against taking anagrelide if you are trying to become pregnant or to father a child. Please see our pregnancy section for more information on pregnancy in MPNs.
Who will prescribe anagrelide for me? Your doctor, specially-trained nurse, hospital pharmacist or sometimes your GP will prescribe your medication.
Can I drive? Anagrelide is not known to cause drowsiness that could affect your driving, however if you are feeling drowsy or fatigued for any reason do not drive.
Do I need to take any special precautions? Do not take more than four tablets at the same time; it is much better to spread them out through the day. Generally avoid strenuous exercise and drinking tea or coffee within thirty minutes of taking anagrelide.
Taking other medications Whenever you take anagrelide (or in fact any medication), it is important to inform your medical advisors about all other medications you are taking: this includes medicines prescribed for you as well as any vitamins, herbal supplements or remedies bought in chemists. Always provide the names of these medications and remedies to the hospital doctors, GPs, nurses and pharmacists who are treating you, prescribing additional medications or giving you advice. It can be very helpful to carry a list of the names and dosages of all your medicines to show to your doctor or nurse at appointments.
Can I have vaccinations such as the flu jab? Yes, you can have most vaccinations including the flu vaccine whilst taking anagrelide. Some vaccinations are live vaccines and these should not be taken with anagrelide. It is important you tell the person giving you the vaccine that you are taking anagrelide so they can verify it is safe for you to be vaccinated.
If you’d like more information you can download our leaflets about MPN medications.