Anagrelide side effects and adverse events, review of benefits and danger, caution, warning

Anagrelide is a pharmaceutical drug for thrombocythemia treatment. it is used to decrease the number of platelets (a type of blood cell that is needed to control bleeding) in the blood of patients who have a myeloproliferative disorder (condition in which the body makes too many of one or more types of blood cells) such as essential thrombocythemia (condition in which the body makes too many platelets) or polycythemia vera (condition in which the body makes too many red blood cells and sometimes too many platelets). Anagrelide is in a class of medications called platelet-reducing agents. It works by slowing the production of platelets in the body.

Benefit of anagrelide
Thrombocytosis is a common feature of chronic myeloproliferative disorders (MPD) and may be asymptomatic or associated with transient microvascular vaso-occlusive symptoms or large vessel arterial or venous thrombosis. Asymptomatic thrombocytosis in young MPD patients with no cardiovascular risk factors does not require treatment. Lowering the platelet count reduces the incidence of microvascular events in MPD patients. At the same time, no study to date has demonstrated that platelet count reduction prolongs survival in MPD patients. Agents such as hydroxyurea, busulfan, IFN-alpha and anagrelide, have been used to reduce an elevated platelet count and decrease thrombohemorrhagic events in at-risk patients with thrombocytosis associated with an MPD. Hydroxyurea plus low-dose aspirin is superior to anagrelide plus low-dose aspirin for patients with essential thrombocythemia at high risk for vascular events.

Anagrelide side effects
Leg ulcers associated with intake of anagrelide.
Dtsch Med Wochenschr. 2007.
Extremely painful leg ulcers on the lateral aspect of both ankles developed in a 38-year-old man for the first time six weeks after starting treatment with anagrelide for thrombocythemia. Extensive diagnostic tests, including laboratory tests, Doppler and duplex ultrasound of the superficial and deep leg veins, histopathology and bacteriological and mycological tests excluded vascular disease, vasculitis and metabolic causes. Despite adequate local treatment the ulcerations did not improve until anagrelide was discontinued and replaced by hydroxyurea. Anagrelide administration was the most likely cause of the leg ulcerations, even though this possible side effect has only been described once in the literature.

Emails
Is the combination of Actos, a pharmaceutical drug used by diabetics acceptable with anagrelide treatment? What about using it in combination with antipsychotic medications. My sister takes Arcoxia for the past few months and she visits a doctor who does Ayurveda practice and prescribes Ayurvedic herbs which include ashwagandha and bacopa along with Triphala. She is also considering taking tongkat ali supplement.
   We have not seen research regarding these combinations of medications and herbs.