Fluoxetine with Anagrelide Interaction Details
Brand Names Associated with Fluoxetine
- Fluoxetine
- Prozac®
- Prozac® Weekly
- Rapiflux®
- Sarafem®
- Selfemra®
- Symbyax® (as a combination product containing Fluoxetine, Olanzapine)
Brand Names Associated with Anagrelide
- Agrylin®
- Anagrelide
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 11, 2023
Interaction Effect
An increased risk of bleeding and an increased risk of QT interval prolongation
Interaction Summary
Avoid coadministering anagrelide with FLUoxetine. Anagrelide is associated with reports of ventricular arrhythmia 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 . Additionally, anagrelide reduces platelet count 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 .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Coadministration of FLUoxetine with a drug known to prolong the QT interval, such as anagrelide, should be avoided. FLUoxetine use is associated with reports of QT interval prolongation and ventricular arrhythmia, included torsade de pointes. Concomitant use of FLUoxetine and other QT prolonging drugs may result in additive prolongation of the QT interval. Consider ECG assessment and periodic ECG monitoring if initiating treatment with FLUoxetine in patients with risk factors for QT interval prolongation and ventricular arrhythmia. Discontinue FLUoxetine and obtain a cardiac evaluation if patients develop signs or symptoms consistent with ventricular arrhythmia. Additionally, concomitant use of FLUoxetine with antiplatelets, such as anagrelide, may increase risk of bleeding. Closely monitor for bleeding for patients receiving antiplatelets when FLUoxetine is initiated or discontinued.
Mechanism Of Interaction
Release of serotonin by platelets; additive effects on hemostasis; additive QT interval prolongation
Fluoxetine Overview
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Fluoxetine is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), some eating disorders, and panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Fluoxetine is also used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. It is also used along with olanzapine (Zyprexa) to treat depression that did not respond to other medications and episodes of depression in people with bipolar I disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Fluoxetine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
Anagrelide Overview
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Anagrelide 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 bone marrow disorder, 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.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.