Anagrelide (Agrylin) is a selective thrombocytopenic agent primarily used to treat thrombocythemia secondary to myeloproliferative neoplasms. It reduces the risk of thrombosis and improves related symptoms by lowering platelet counts.

How to Use Anagrelide (Agrylin)

Dosing Regimen

Adults: The initial dose is 0.5 mg four times daily or 1 mg twice daily, with capsules swallowed whole.

Children (≥ 7 years old): The initial dose is 0.5 mg once daily.

Maintenance dose: After maintaining the initial dose for at least 1 week, adjust the dose gradually. The weekly dose increment should not exceed 0.5 mg/day, the single dose should not exceed 2.5 mg, and the total daily dose should not exceed 10 mg.

Dose Adjustment of Anagrelide (Agrylin)

Adjustment Based on Platelet Response

Monitoring frequency: Platelet counts should be monitored weekly during the initial phase of treatment; after reaching the target, monitoring can be changed to monthly or as needed.

Adjustment principle: If platelets do not reach the target (> 600,000/μL), the dose can be increased by 0.5 mg/day weekly until therapeutic effects are observed.

The effective dose for most patients is 1.5–3.0 mg/day.

Rebound after discontinuation: When treatment is interrupted, platelets may increase again within 4 days and return to baseline levels within 1–2 weeks, requiring close monitoring.

Adjustment for Patients with Hepatic Impairment

Moderate hepatic impairment (Child-Pugh score 7–9): Reduce the initial dose to 0.5 mg/day, and the subsequent weekly dose increment should not exceed 0.5 mg/day.

Severe hepatic impairment: Avoid use.

Precautions for Anagrelide (Agrylin) Use in Special Populations

Children and Adolescents

Safety: Adverse reactions in children ≥ 7 years old are similar to those in adults (e.g., headache, fever, epistaxis), but fluctuations in heart rate and blood pressure need to be monitored.

Pharmacokinetic differences: Pediatric doses require individualization, as plasma drug concentrations in children may be higher than those in adults.

Pregnancy and Lactation

Pregnancy: Animal studies have shown fetal developmental delay; human data are limited. The risk of thrombosis and potential fetal effects must be weighed.

Lactation: The drug can pass into rat milk. It is recommended to avoid breastfeeding during treatment and for 1 week after drug discontinuation.

Patients with Hepatic or Renal Impairment

Hepatic impairment: Dose reduction is required for patients with moderate hepatic impairment; use is contraindicated in those with severe hepatic impairment.

Renal impairment: No dose adjustment is needed for patients with severe renal impairment (CrCl < 30 mL/min).