I also take Anagrelide twice daily because I have had skin cancers and HU is knwn to be problematic regarding tumors. Very good luck with platelet reduction with Anagrelide, no obvious side effects caused by the medication.

Patients and blood specialists' opinions can differ. The first specialist I saw for ET back in 2020 wanted my platelets in normal range, 450 or less, and would only prescribe HU. That made me sick. I changed to my current MPN specialist, Dr. Drazin at Cedars Sinai Hematology and Oncology. He switched me to Anagrelide and is pleased with the result. He wants my platelets "out of dangerous range" but does not try to get them down to 450. My platelets are currently in the 500's while I take 0.5 mg Anagrelide twice daily.

That’s a lot of medication. I can see why you are tired. Were your platelets really high? What is the platelet count now ?

I’m taking both Agrylin and Hydrea. The 2 of them have me in the normal range. Dr increased Hydrea to 4 pills a day, twice a week, but that was intolerable. A year ago Jakafi began, but that just made the plates go crazy. I started Agrylin in Feb of this year. I don’t feel any worse than I have. Still have only about 2 hours of work per day. Still get very tired.

The goal is to lead as normal a life as possible, while avoiding a blood clot that could lead to worse things. I've got the time and insurance coverage to explore side effect issues. Good luck to you as well.