Anagrelide is a selective platelet-producing inhibitor, approved for marketing in the United States in 1997, and subsequently approved in Europe and other regions.
Anagrelide's Standard Dosage
1. Standard Dosage for Adults with Thrombocytosis
Initial Anagrelide Dosage
0.5 mg orally four times daily; or 1 mg orally twice daily for at least 7 days.
Maintenance Anagrelide Dosage
Adjust to the lowest effective dose required to reduce and maintain the platelet count below 600,000/µL (ideally to normal levels). Dosage increases within any one week should not exceed 0.5 mg/day.
The total dose should not exceed 10 mg/day, and a single dose should not exceed 2.5 mg.
2. Standard Dosage for Children with Chronic Myeloid Leukemia
Initial Anagrelide Dosage
0.5 mg orally daily (recommended dose) to 0.5 mg orally four times daily, as directed by your physician.
Anagrelide Maintenance Dose
Adjust to the lowest effective dose required to lower and maintain the platelet count below 600,000/µL (ideally to normal levels). Dosage increases within any one week should not exceed 0.5 mg/day.
The total dose should not exceed 10 mg/day, and a single dose should not exceed 2.5 mg.
3. Routine Dosage for Thrombocytosis in Children
Anagrelor Initial Dose
0.5 mg orally daily (recommended dose) to 0.5 mg orally four times daily.
Anagrelor Maintenance Dose
Adjust to the lowest effective dose required to lower and maintain the platelet count below 600,000/µL (ideally to normal levels). Dosage increases within any one week should not exceed 0.5 mg/day.
The total dose should not exceed 10 mg/day, and a single dose should not exceed 2.5 mg.
Anagrelide Monitoring Recommendations
1. Hematology
Plate count (every 2 days during week 1 of treatment, then at least weekly until a maintenance dose is determined); hemoglobin and white blood cell count (first 2 weeks of treatment).
2. Liver Function
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (first 2 weeks of treatment).
3. Renal Function
Serum creatinine and blood urea nitrogen (BUN) (first 2 weeks of treatment).
Anagrelide Dose Adjustment
1. Dose Adjustment in Renal Impairment
(1) Moderate Hepatic Impairment
A single 1 mg dose increases the total exposure (AUC) of anagrelide by 8-fold.
(2) Severe Renal Impairment
A single 1 mg dose has no significant effect on the pharmacokinetics of anagrelide.
2. Dose Adjustment in Hepatic Impairment
(1) Anagrelide is contraindicated in patients with severe hepatic impairment.
(2) The starting dose for patients with moderate hepatic impairment should be 0.5 mg/day and maintained at this dose for at least 1 week (during which cardiovascular effects should be closely monitored). The dose increase within any 1 week should not exceed 0.5 mg/day.
