Platelet Promacta and Nplate in ITP

Romiplostim/Nplate and Eltrombopag/Promacta

How do these medications work?

Nplate and Promacta are medications that belong to a class of ITP therapy (both were FDA approved in 2008) that work to stimulate the blood factory (or bone marrow) to make more platelets. While these medications do not cure ITP, the increased production of platelets can be enough to improve the platelet count.

These medications have been shown to work in greater than 80% of adults with ITP after 6-12 weeks. There are fewer data in childhood ITP. 

	Nplate	Promacta
How is it given?	Weekly injection (under the skin)	Once a day pill
Common side effects	Headache, dizziness, muscle pain, tingling in hands/feet, indigestion	Headaches, nausea, vomiting, diarrhea
Potential serious side effects	Bone marrow scarring (reticulin deposition), a drop in platelet count once medication is stopped, blood clots	Bone marrow scarring  (reticulin deposition), a drop in platelet count once medication is stopped, liver damage, blood clots

 What else do I need to know?

The medication is started at a low dose and is increased until an optimal response is achieved. The response to these medications requires close monitoring. The hematology or pharmacist will assist your provider to make that appropriate blood work has been done. In general, the platelets are checked once a week until the platelet count is stable between 50,000 - 200,000 for 4 weeks. Monitoring becomes less frequent once the platelet response is documented. Of note, our clinical experience has shown that individual responses may be different with Nplate versus Promacta.

Your provider will discuss with you the risks and benefits of these medications and the need for a test called a bone marrow biopsy to assess for bone marrow scarring. In general, the bone marrow scarring is rare and has been shown to be reversible when the drug is stopped.

Questions?

This is not specific to your child but provides general information. If you have questions, please ask your provider.

Reviewed 8/2017

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