Anagrelide

Anagrelide is used to decrease the number of platelets (a type of blood cell that is needed to control bleeding) in the blood of patients who have a bone marrow disorder, in which the body makes too many of one or more types of blood cells, such as essential thrombocythemia (condition in which the body makes too many platelets) or polycythemia vera (condition in which the body makes too many red blood cells and sometimes too many platelets). Anagrelide is in a class of medications called platelet-reducing agents. It works by slowing the production of platelets in the body.

Anagrelide comes as a capsule to take by mouth. It is usually taken with or without food two to four times a day. Take anagrelide at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take anagrelide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of anagrelide and gradually increase your dose, not more often than once a week. Your doctor may change your dose during your treatment based upon your body's response to the medication. Follow these directions carefully.

Anagrelide may help control your condition but will not cure it. Continue to take anagrelide even if you feel well. Do not stop taking anagrelide without talking to your doctor. If you suddenly stop taking anagrelide, the number of platelets in your blood will increase and you may experience symptoms.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking anagrelide,

• tell your doctor and pharmacist if you are allergic to anagrelide or any other medications.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking anagrelide Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• The following nonprescription products may interact with anagrelide: aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs)[ ibuprofen (Advil, Motrin, others), naproxen (Aleve, Naprosyn, others)], and cimetidine (Tagamet). Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking anagrelide. Do not start any of these medications while taking anagrelide without discussing with your healthcare provider.
• tell your doctor if you have or have ever had bleeding problems; high or low blood pressure; lactose intolerance (inability to digest dairy products) or heart, kidney, or liver disease.
• do not take anagrelide if you are pregnant or plan to become pregnant.You should use an effective form of birth control to prevent pregnancy during your treatment with anagrelide. Talk to your doctor about types of birth control that are right for you. If you become pregnant while taking anagrelide, call your doctor immediately. Do not breast-feed while you are taking anagrelide.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking anagrelide.
• you should know that anagrelide may make you dizzy, especially when you first start taking the medication. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know that anagrelide may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking anagrelide. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Anagrelide may make your skin sensitive to sunlight.

Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medication.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Anagrelide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• gas
• nausea
• vomiting
• diarrhea
• constipation
• stomach pain
• heartburn
• belching
• loss of appetite
• runny nose
• nosebleed
• sore throat
• mouth sores
• dizziness
• depression
• nervousness
• forgetfulness
• confusion
• difficulty falling asleep or staying asleep
• lack of energy or sleepiness
• weakness
• muscle, joint or back pain
• leg cramps
• hair loss
• fever
• flu-like symptoms
• painful urination
• ringing in the ears
• itching

If you experience any of the following symptoms, call your doctor immediately:

• rash
• hives
• unusual bleeding or bruising
• blood in urine or stool
• black or tarry stools
• chest pain
• fluttering sensation in the chest
• fast, forceful, or irregular heartbeats
• swelling of the arms, hands, feet, ankles or lower legs
• difficulty breathing
• cough
• slow or difficult speech
• fainting
• weakness or numbness of an arm or leg
• pain, burning, or tingling in the hands or feet
• seizure
• changes in vision

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light or excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• unusual bleeding or bruising

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to anagrelide.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Agrylin^®