Generic name: romiplostim [ROM-i-PLOS-tim]
Drug class: Platelet-stimulating agents
Medically reviewed by Philip Thornton, DipPharm. Last updated on Feb 23, 2024.
What is Nplate?
Nplate is a man-made form of a protein that increases production of platelets (blood-clotting cells) in your body.
Nplate is a prescription medicine used to prevent bleeding episodes in people with chronic immune thrombocytopenic purpura (ITP), a bleeding condition caused by a lack of platelets in the blood.
Nplate is for use in adults and children who are at least 1 year old.
Nplate is also used to treat people including newborns who have been exposed to high levels of radiation (acute radiation syndrome). The effectiveness of Nplate for this use was only studied in animals, because it could not be studied in people.
Warnings
Nplate is not a cure for ITP and it will not make your platelet counts normal if you have this condition.
Nplate may increase your risk of a blood clot or stroke. Call your doctor right away if you have signs of a blood clot, such as sudden numbness or weakness on one side of the body, chest pain, problems with speech or balance, warmth or swelling in an arm or leg.
Before you use Nplate, tell your doctor if you have kidney or liver disease.
Using Nplate long-term can cause harmful effects on your bone marrow that may result in serious blood cell disorders. To be sure this medication is helping your condition and not causing harmful effects, your blood will need to be tested often. Do not miss any scheduled visits to your doctor.
It may take up to 4 weeks of using this medicine before it is completely effective in preventing bleeding episodes. Talk with your doctor if you have any bruising or bleeding episodes after 4 weeks of treatment.
After you stop using Nplate, your risk of bleeding may be even higher than it was before you started treatment. Be extra careful to avoid cuts or injury for at least 2 weeks after you stop using Nplate. Your blood will need to be tested weekly during this time.
Before taking this medicine
You should not use Nplate if you are allergic to romiplostim.
Using Nplate may increase your risk of developing blood cancers, especially if you have a myelodysplastic syndrome (bone marrow failure disorder, sometimes called "preleukemia"). Talk with your doctor if you have concerns about this risk.
To make sure Nplate is safe for you, tell your doctor if you have ever had:
blood or bone marrow cancer such as leukemia, or myelodysplastic syndrome;
bleeding problems or a blood clot;
surgery to remove your spleen; or
liver disease.
It is not known whether romiplostim will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
If you are pregnant, your name may be listed on a pregnancy registry to track the effects of romiplostim on the baby.
You should not breastfeed while using Nplate.
Nplate pregnancy and breastfeeding warnings (more detail)
How is Nplate given?
Nplate is injected under the skin, usually once per week. A healthcare provider will give you this injection.
It may take up to 4 weeks of before Nplate is completely effective in preventing bleeding episodes. Keep receiving the medication as directed. Talk with your doctor if you have any bruising or bleeding episodes after 4 weeks of treatment.
Using Nplate long-term can cause harmful effects on your bone marrow that may result in serious blood cell disorders. You will need frequent blood tests. Your treatment with this medicine may be delayed or permanently discontinued based on the results.
After you stop using Nplate, your risk of bleeding may be even higher than it was before you started treatment. Be extra careful to avoid cuts or injury for at least 2 weeks after you stop using Nplate. Your blood will need to be tested weekly during this time.
Dosing information
Usual Adult Dose for Idiopathic (Immune) Thrombocytopenic Purpura:
Initial dose: 1 mcg/kg subcutaneous injection once a week based on actual body weight; adjust the weekly dose by increments of 1 mcg/kg until the patients achieves a platelet count of 50 x 10(9)/L or greater
Maintenance dose: Use the lowest dose to achieve and maintain a platelet count of 50 x 10(9)/L or greater as needed to reduce bleeding risk.
Maximum dose: 10 mcg/kg/week
Duration of therapy: Discontinue this drug if platelets remain insufficient to avoid clinically important bleeding after 4 weeks at the maximum dose.
Comments: In clinical studies, most patients who responded to this drug achieved and maintained platelet counts of 50 x 10(9)/L or greater with a median dose of 2 mcg/kg.
Use: Treatment of thrombocytopenia in patients with chronic immune thrombocytopenia (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy; use only in patients with ITP whose degree of thrombocytopenia and clinical condition increases the risk for bleeding.
Usual Pediatric Dose for Idiopathic (Immune) Thrombocytopenic Purpura:
1 Year or Older:
Initial dose: 1 mcg/kg subcutaneous injection once a week based on actual body weight; adjust the weekly dose by increments of 1 mcg/kg until the patients achieves a platelet count of 50 x 10(9)/L or greater
Maintenance dose: Use the lowest dose to achieve and maintain a platelet count of 50 x 10(9)/L or greater as needed to reduce bleeding risk.
Maximum dose: 10 mcg/kg/week
Comments:
-Dose adjustments are based on changes in platelet counts and changes in body weight. Reassessment of body weight is recommended every 12 weeks.
-In a pediatric placebo-controlled clinical study, the median dose was 5.5 mcg/kg.
Use: Treatment of thrombocytopenia in patients with immune thrombocytopenia (ITP) for at least 6 months who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy; use only in patients with ITP whose degree of thrombocytopenia and clinical condition increases the risk for bleeding.
Detailed Nplate dosage information
What happens if I miss a dose?
Call your doctor for instructions if you miss an appointment for your Nplate injection.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while receiving Nplate?
Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.
Nplate side effects
Get emergency medical help if you have signs of an allergic reaction to Nplate: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
severe or ongoing diarrhea;
purple or red spots under your skin;
signs of an ear infection (more common in children) - fever, ear pain or full feeling, trouble hearing, drainage from the ear, fussiness in a child;
signs of a stroke - sudden numbness or weakness (especially on one side of the body), severe headache, slurred speech, balance problems;
signs of a blood clot in the lung - chest pain, sudden cough, wheezing, rapid breathing, coughing up blood; or
signs of a blood clot in your leg - swelling, warmth, or redness in an arm or leg.
Common Nplate side effects may include:
bruising;
headache;
dizziness;
joint pain, muscle weakness or tenderness;
pain in your arms, legs, or shoulder;
numbness or tingling in your hands or feet;
trouble sleeping;
stomach pain, indigestion, nausea, vomiting, diarrhea;
cough, wheezing, chest tightness, trouble breathing;
stuffy nose, sneezing, sinus pain; or
pain in your mouth and throat.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Nplate side effects (more detail)
What other drugs will affect Nplate?
Other drugs may interact with romiplostim, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.
Nplate drug interactions (more detail)
Popular FAQ
Nplate starts working from the first dose to increase platelet counts. Nplate works quickly to increase platelets. The median time to first platelet response was 2.1 weeks, according the the results of a single-arm, open-label study conducted in 75 adults with immune thrombocytopenia.
Nplate should be discontinued after 4 weeks of treatment at the maximum dose of 10 mcg/kg a week if platelet counts have not increased to sufficient levels. Continue reading
No, Nplate is not a chemotherapy (cancer) drug, it is a prescription medicine used to treat low platelet counts that can lead to bleeding in people with chronic immune thrombocytopenic purpura (ITP). Continue reading
Nplate (romiplostim) is a once-weekly subcutaneous injection that is administered by your healthcare provider and which is used to treat thrombocytopenia in certain patients with immune thrombocytopenia (ITP) who have not responded well enough to corticosteroids, immunoglobulins or splenectomy. Continue reading
Nplate (romiplostim) is a biological drug used to treat immune thrombocytopenia (ITP, low blood platelet counts) and increase survival in people exposed to high doses of radiation who have hematopoietic syndrome of acute radiation syndrome (HS-ARS) . Continue reading
No, hair loss (alopecia) was not reported by patients in clinical studies for Nplate. If you are experiencing hair thinning or hair loss that is concerning for you, you may want to talk with your healthcare provider. It may be due to a medical condition or another medication you take. Continue reading
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Professional resources
- Nplate prescribing information
- Romiplostim (AHFS Monograph)
Related treatment guides
- Immune Thrombocytopenia
Further information
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Nplate only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medical Disclaimer
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