Anagrelide Hydrochloride

ANAGRELIDE HYDROCHLORIDE- anagrelide hydrochloride capsule
Carilion Materials Management

1 INDICATIONS AND USAGE

Anagrelide capsules USP are indicated for the treatment of patients with thrombocythemia, secondary to myeloproliferative neoplasms, to reduce the elevated platelet count and the risk of thrombosis and to ameliorate associated symptoms including thrombo-hemorrhagic events [see Clinical Studies (14), Dosage and Administration (2)].

2 DOSAGE AND ADMINISTRATION

2.1 Starting Dose

Adults: The recommended starting dosage of anagrelide capsules is 0.5 mg four times daily or 1 mg twice daily.

Pediatric Patients: The recommended starting dosage of anagrelide capsules is 0.5 mg daily.

2.2 Titration

Continue the starting dose for at least one week and then titrate to reduce and maintain the platelet count below 600,000/μL, and ideally between 150,000/μL and 400,000/μL. The dose increment should not exceed 0.5 mg/day in any one week. Dosage should not exceed 10 mg/day or 2.5 mg in a single dose [see Warnings and Precautions (5)]. Most patients will experience an adequate response at a dose of 1.5 to 3 mg/day. Monitor platelet counts weekly during titration then monthly or as necessary.

2.3 Dose Modifications for Hepatic Impairment

In patients with moderate hepatic impairment (Child Pugh score 7 to 9) start anagrelide capsules therapy at a dose of 0.5 mg/day and monitor frequently for cardiovascular events [see Warnings and Precautions ( 5.1 ), Use in Specific Populations ( 8.6 ) and Clinical Pharmacology ( 12.3 )] . Patients with moderate hepatic impairment who have tolerated anagrelide capsules therapy for one week may have their dose increased. The dose increase increment should not exceed 0.5 mg/day in any one week. Avoid use of anagrelide capsules in patients with severe hepatic impairment.

2.4 Clinical Monitoring

Anagrelide capsules therapy requires clinical monitoring, including complete blood counts, assessment of hepatic and renal function, and electrolytes.

To prevent the occurrence of thrombocytopenia, monitor platelet counts every two days during the first week of treatment and at least weekly thereafter until the maintenance dosage is reached. Typically, platelet counts begin to respond within 7 to 14 days at the proper dosage. In the clinical trials, the time to complete response, defined as platelet count ≤ 600,000/μL, ranged from 4 to 12 weeks. In the event of dosage interruption or treatment withdrawal, the rebound in platelet count is variable, but platelet counts typically will start to rise within 4 days and return to baseline levels in one to two weeks, possibly rebounding above baseline values. Monitor platelet counts frequently.

3 DOSAGE FORMS AND STRENGTHS

Anagrelide Capsules, 0.5 mg are available as light gray opaque cap/white opaque body hard gelatin capsules, spin printed in black ink “Ivax hourglass logo” “5241” on the cap and “0.5 mg” on the body containing 0.5 mg of anagrelide base (as anagrelide hydrochloride).

Anagrelide Capsules, 1 mg are available as white opaque hard gelatin capsules, spin printed in black ink “Ivax hourglass logo” “5240” on the cap and “1 mg” on the body containing 1 mg of anagrelide base (as anagrelide hydrochloride).

4 CONTRAINDICATIONS

None.

5 WARNINGS AND PRECAUTIONS

5.1 Cardiovascular Toxicity

Torsades de pointes and ventricular tachycardia have been reported with anagrelide. Obtain a pre-treatment cardiovascular examination including an ECG in all patients. During treatment with anagrelide monitor patients for cardiovascular effects and evaluate as necessary.

Anagrelide increases the QTc interval of the electrocardiogram and increases the heart rate in healthy volunteers [see Clinical Pharmacology ( 12.2 )] .

Do not use anagrelide in patients with known risk factors for QT interval prolongation, such as congenital long QT syndrome, a known history of acquired QTc prolongation, medicinal products that can prolong QTc interval and hypokalemia [see Drug Interactions ( 7.1 )] .

Hepatic impairment increases anagrelide exposure and could increase the risk of QTc prolongation. Monitor patients with hepatic impairment for QTc prolongation and other cardiovascular adverse reactions. The potential risks and benefits of anagrelide therapy in a patient with mild and moderate hepatic impairment should be assessed before treatment is commenced. Reduce anagrelide dose in patients with moderate hepatic impairment. Use of anagrelide in patients with severe hepatic impairment has not been studied [see Dosage and Administration ( 2.3 ), Use in Specific Populations ( 8.6 ) and Clinical Pharmacology ( 12.2 , 12.3 )] .

In patients with heart failure, bradyarrhythmias, or electrolyte abnormalities, consider periodic monitoring with electrocardiograms [see Clinical Pharmacology ( 12.2 )] .

Anagrelide is a phosphodiesterase 3 (PDE3) inhibitor and may cause vasodilation, tachycardia, palpitations, and congestive heart failure. Other drugs that inhibit PDE3 have caused decreased survival when compared with placebo in patients with Class III-IV congestive heart failure [ see Drug Interactions (7.2)].

In patients with cardiac disease, use anagrelide only when the benefits outweigh the risks.

5.2 Bleeding Risk

Use of concomitant anagrelide and aspirin increased major hemorrhagic events in a postmarketing study. Assess the potential risks and benefits for concomitant use of anagrelide with aspirin, since bleeding risks may be increased. Monitor patients for bleeding, including those receiving concomitant therapy with other drugs known to cause bleeding (e.g., anticoagulants, PDE3 inhibitors, NSAIDs, antiplatelet agents, selective serotonin reuptake inhibitors) [see Drug Interactions (7.3), Clinical Pharmacology (12.3)].

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