Drug Interaction Report

Anagrelide and Fluoxetine: Interaction Details

A pharmacist-reviewed analysis of the Anagrelide and Fluoxetine interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Anagrelide

Agrylin Agrylin®
+

Fluoxetine

RECONCILE
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 434 documented Anagrelide interactions, 376 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
theoretical
Severity
Major

What happens

An increased risk of bleeding and an increased risk of QT interval prolongation

Interaction Deep Dive

Avoid coadministering anagrelide with FLUoxetine. Anagrelide is associated with reports of ventricular arrhythmia2 and FLUoxetine is known to prolong QT interval; concomitant use of FLUoxetine and QT-prolonging drugs may result in additive prolongation of the QT interval 1. Additionally, anagrelide reduces platelet count 2 and FLUoxetine is an SSRI. The release of serotonin by platelets is important for maintaining hemostasis. SSRIs may increase bleeding risk. Epidemiologic case-control and cohort studies have shown an association between drugs like FLUoxetine that interfere with serotonin reuptake and gastrointestinal bleeding. Concomitant use with antiplatelets may increase this risk. Closely monitor for bleeding for patients receiving antiplatelets when FLUoxetine is initiated or discontinued 1.

Why it happens (mechanism)

Release of serotonin by platelets; additive effects on hemostasis; additive QT interval prolongation

Common questions

Can I take Anagrelide and Fluoxetine together?

An increased risk of bleeding and an increased risk of QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.

How serious is the Anagrelide and Fluoxetine interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

Questions for your pharmacist

  • Does my dose of Anagrelide or Fluoxetine need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (2)

  1. Product Information: PROZAC(R) oral capsules, fluoxetine oral capsules. Lilly USA LLC (per FDA), Indianapolis, IN, 2023. DailyMed
  2. Product Information: AGRYLIN(R) oral capsules, anagrelide HCl oral capsules. Shire US Inc. (per FDA), Wayne, PA, 2013. DailyMed
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Anagrelide

Keep reading about Anagrelide

All Anagrelide interactions (434) Anagrelide drug information
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Fluoxetine

Keep reading about Fluoxetine

All Fluoxetine interactions (142)
Also serious with: Linezolid Injection Moxifloxacin Ophthalmic Palonosetron Injection Loperamide
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Anagrelide + Activated Charcoal Danshen Piracetam Aconite Adrafinil African Wild Potato Allspice Aloe + 257 more
Fluoxetine + Activated Charcoal American Hellebore Arsenic Cesium Ephedra Grapefruit Lithium Sida Cordifolia + 155 more

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.