I’ve been taking anagrelide .5 mg daily for 4 1/2 years and doing well with it. At first I had heart palpitations, but that subsided, so I would say the only side effect I’ve had is occasional hot flashes. My oncologist wants me to change to hydroxurea at some point - I need to find out if that’s because of long term effects. Right now I’m very happy staying on anagrelide. I have no fatigue, no hair loss, no brittle nails that I hear of the side effects with hydroxurea.