Thromboreductin Drug Interactions

Limited pharmacokinetic and/or pharmacodynamic studies investigating possible interactions between anagrelide and other medicinal products have been conducted.
Effects of other substances on anagrelide: Anagrelide is primarily metabolised by CYP1A2. CYP1A2 is inhibited by several medicinal products, including fluvoxamine and enoxacin, and such medicinal products could theoretically adversely influence the clearance of anagrelide. CYP1A2 inducers (such as omeprazole) could decrease the exposure of anagrelide (see Pharmacology: Pharmacokinetics under Actions).
In vivo interaction studies in humans have demonstrated that digoxin and warfarin do not affect the pharmacokinetic properties of anagrelide.
Caution should be taken when using anagrelide with medicinal products that can prolong the QTc interval and hypokalaemia.
Effects of anagrelide on other substances: Anagrelide demonstrates a somewhat limited inhibitory activity towards CYP1A2, which may present a potential for interaction with other co-administered medicinal products sharing this clearance mechanism e.g. theophylline.
Anagrelide is an inhibitor of PDE III. The effects of medicinal products with similar properties such as the inotropes milrinone, enoximone, amrinone, olprinone and cilostazol may be exacerbated by anagrelide.
At the doses recommended for use in the treatment of essential thrombocythaemia, anagrelide may theoretically potentiate the effects of other medicinal products that inhibit or modify platelet function, e.g. acetylsalicylic acid.
Co-administration of repeat-dose anagrelide and acetylsalicylic acid may enhance the anti-platelet aggregation effects of each drug compared with administration of acetylsalicylic acid alone. In some ET patients concomitantly treated with acetylsalicylic acid and anagrelide formulations, major haemorrhages occurred. Therefore, due to the lack of data in ET patients, the potential risks of the simultaneous use of anagrelide with acetylsalicylic acid should be assessed before treatment is initiated, particularly in patients with a high risk profile for haemorrhage.
Anagrelide may cause intestinal disturbance in some patients and compromise the absorption of hormonal oral contraceptives.
Food interactions: Food delays the absorption of anagrelide but does not significantly alter systemic exposure. The effects of food on bioavailability are not considered clinically relevant to the use of anagrelide.