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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)