Nplate (romiplostim), is an antihemorrhagic. This member of the thrombopoietin (TPO) mimetic class is an Fc-peptide fusion protein (peptibody) that activates intracellular transcriptional pathways leading to increased platelet production via the TPO receptor (also known as cMpl), a mechanism analogous to endogenous TPO.
Nplate is specifically indicated for the treatment of thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulins or splenectomy.
Nplate is supplied as sterile solution (250 mcg and 500 mcg) designed for subcutaneous administration. Nplate must be reconstituted with preservative-free Sterile Water for Injection. The recommended initial dose of the drug is 1 mcg/kg once weekly based on actual body weight, as a subcutaneous injection.
Use the actual body weight at initiation of therapy, then adjust the weekly dose of Nplate by increments of 1 mcg/kg until the patient achieves a platelet count of greater than or equal to 50 x 109/L as necessary to reduce the risk for bleeding; do not exceed a maximum weekly dose of 10 mcg/kg.
If the platelet count is < 50 x 109/L, increase the dose by 1 mcg/kg.
If platelet count is > 200 x 109/L for 2 consecutive weeks, reduce the dose by 1 mcg/kg.
If platelet count is > 400 x 109/L, do not dose. Continue to assess the platelet count weekly. After the platelet count has fallen to < 200 x 109/L, resume Nplate at a dose reduced by 1 mcg/kg.
If platelet count does not increase after 4 weeks at the maximum weekly dose of 10 mcg/kg, Nplate should be discontinued.
Adverse reactions associated with the use of Nplate may include, but are not limited to, the following:
Nplate (romiplostim) is a thrombopoietin (TPO) mimetic belonging to the antihemorrhagic class. This Fc-peptide fusion protein (peptibody) activates intracellular transcriptional pathways that lead to an enhanced production of platelets via the TPO receptor (cMpl), working in a way that is similar to the natural functioning of endogenous TPO.