Last update Oct. 30, 2023

Anagrelide Hydrochloride

High Risk

Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.

Anagrelide is a cyclic AMP phosphodiesterase-3 inhibitor that reduces platelet production and, at doses higher than therapeutic, inhibits platelet aggregation. It is used to treat primary (essential) thrombocythemia and thrombocythemia secondary to other myeloproliferative disorders. Oral administration in one or two daily doses.

On latest update relevant data on breastfeeding were not found.

Since it is usually prescribed for long-term treatment and it does not have a low oral bioavailability, infant coagulation could be affected.

It is known from pharmacokinetics that after 3 elimination half-lives (T½), 87.5% of the drug is eliminated from the organism; after 4 T½  it is 94%, after 5 T½, 96.9%, after 6 T½, 98.4% and after 7 T½, 99%. From 7 T½ the plasma concentrations of the drug in the body are negligible. In general, a period of at least five half-lives can be considered a safe waiting period before breastfeeding again. (Anderson 2016)

Taking the longest published T½ of all the active metabolites (2,5 hours) as a reference, these 5 T½ would correspond to 12,5 hours. Meanwhile, express and discard milk from the breast regularly to maintain production.

If used during lactation, it is advisable to monitor the infant's platelet count.

Given the strong evidence for the benefits of breastfeeding for infant development and maternal health, it is appropriate to assess the risk-benefit of any maternal treatment, including chemotherapy, by individually counseling each mother who wishes to continue breastfeeding. (Koren 2013)

Alternatives

  • Aspirin (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Hydroxycarbamide (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Interferon Alfa (IFN-α) ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Anagrelide Hydrochloride in other languages or writings:

Groups

Anagrelide Hydrochloride belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Anagrelide Hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 70 %
Molecular weight 311 daltons
VD 11.25 l/Kg
Tmax 1 hours
1.5 (metab: 2.5) hours

References

  1. Anderson PO. Cancer Chemotherapy. Breastfeed Med. 2016 May;11:164-5. Abstract Full text (link to original source) Full text (in our servers)
  2. Ramirez G, García-Sanchez R, Plaza S. [Management of patients with essential thrombocythemia]. Med Clin (Barc). 2013 Abstract
  3. Koren G, Carey N, Gagnon R, Maxwell C, Nulman I, Senikas V; Society of Obstetricians and Gynaecologists of Canada. Cancer chemotherapy and pregnancy. J Obstet Gynaecol Can. 2013 Mar;35(3):263-278. Abstract Full text (link to original source) Full text (in our servers)
  4. EMEA Anagrelida Ficha técnica 2009 Full text (in our servers)
  5. EMEA Anagrelide Data Sheet 2009 Full text (in our servers)

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