Anagrelide (Agrylin) is a specific drug used to treat secondary thrombocythemia in myeloproliferative neoplasms. It reduces the risk of thrombosis by lowering platelet count. Its clinical use requires strict vigilance against side effects such as cardiovascular toxicity and bleeding risk.

What are the side effects of Anagrelide (Agrylin)?

Systemic Reactions

High incidence (≥5%): Weakness (23%), edema (21%), pain (15%), fever (9%), peripheral edema (9%), malaise (6%).

Some patients may experience flu-like symptoms or chills.

Cardiovascular System

Palpitations (26%) and tachycardia (8%) are the most common.

Other reactions: Chest pain (8%), arrhythmia, angina pectoris, orthostatic hypotension.

Digestive System

Diarrhea (26%), nausea (17%), and abdominal pain (16%) are the main manifestations.

Minor reactions: Vomiting (10%), abdominal distension (10%), anorexia (8%), dyspepsia (5%).

Nervous System

Headache (44%) has the highest incidence and may persist.

Others: Dizziness (15%), paresthesia (6%), drowsiness or insomnia.

Respiratory System

Dyspnea (12%) and cough (6%) are relatively common.

A small number of patients may experience epistaxis or pneumonia.

Severe Side Effects of Anagrelide (Agrylin) Requiring High Vigilance

Cardiovascular Toxicity

QT interval prolongation: May lead to torsades de pointes. An electrocardiogram must be completed before medication.

Heart failure risk: PDE3 inhibitory effect may exacerbate heart failure.

Clinical management: Avoid use in patients with congenital long QT syndrome.

Regular monitoring of electrolytes (especially blood potassium).

Pulmonary Hypertension and Pulmonary Toxicity

Pulmonary hypertension: Treatment should be initiated only after evaluating underlying cardiopulmonary diseases.

Interstitial lung disease: Manifested as progressive dyspnea, which may occur 1 week to several years after medication.

Bleeding Risk

Combined use with aspirin: The incidence of major bleeding events increases significantly.

High-risk groups: Patients using anticoagulants/antiplatelet drugs concurrently, and elderly patients.

Other Severe Reactions

Pancreatitis: Rarely reported in clinical trials.

Hepatotoxicity: Significant elevation of ALT/AST may occur.

Tubulointerstitial nephritis: Rare but requires renal function monitoring.

Precautions for Anagrelide (Agrylin) Use

Drug Interactions

QT-prolonging drugs: Chloroquine, clarithromycin, amiodarone, etc. (concurrent use is absolutely prohibited).

PDE3 inhibitors: Milrinone, cilostazol (exacerbate cardiovascular side effects).

CYP1A2 inhibitors: Fluvoxamine, ciprofloxacin (increase blood drug concentration).

Medication in Special Populations

Pregnant women: Animal experiments show fetal development delay; the pros and cons need to be weighed.

Lactating women: The drug can be secreted in breast milk; breastfeeding is prohibited during treatment.

Elderly patients: No dose adjustment is needed, but enhanced cardiovascular monitoring is required.

Clinical Monitoring Requirements

Platelet count: Monitor every 2 days in the first week of treatment, then once a week until stable.

Cardiovascular assessment: Electrocardiogram is mandatory before treatment, and re-examination every 3-6 months thereafter.

Liver function: Monthly testing for patients with moderate to severe liver impairment.