Nplate (romiplostim)

Nplate generic or biosimilar

Nplate is available only as a brand-name medication. It is not available as a biosimilar. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug).

Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. A generic drug, on the other hand, refers to drugs made from chemicals. A generic is an exact copy of the active ingredient in a brand-name medication.

Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

Nplate contains the active ingredient romiplostim.

Nplate side effects

Nplate can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while using Nplate. These lists do not include all possible side effects.

For more information on the possible side effects of Nplate, see this article. You can also talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may bother you.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Nplate, you can do so through MedWatch.

Mild side effects

The mild side effects reported more often in adults in clinical trials of Nplate include:

• pain in the joints, muscles, shoulders, arms, or legs
• abdominal pain
• indigestion
• dizziness
• feeling pins and needles in the hands and feet
• insomnia
• headache
• upper respiratory infections, such as the common cold
• cough
• bronchitis
• sinus infection
• nausea and vomiting
• diarrhea
• pain in the mouth and throat

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Nplate aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects, which are explained in more detail below in “Side effect details,” include:

• loss of response to Nplate, which could lead to severe thrombocytopenia
• allergic reaction*
• blood clots*
• new or worsening changes in bone marrow*

* For details about this side effect, see the “Side effect details” section below.

Side effects in children

In clinical trials, the more commonly reported side effects in children who took Nplate were:

• bruising
• upper respiratory infections (URIs)
• mouth and throat pain

If you have concerns about side effects of Nplate in children receiving the drug, talk with your child’s doctor.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on some of the side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after receiving Nplate. But it’s unknown how often this happens with Nplate.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Call your doctor right away if you have a severe allergic reaction to Nplate. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Blood clots

Nplate is used to increase platelet counts in people with certain conditions. However, Nplate can make your platelet count rise too much, a condition called thrombocytosis. This in turn can increase your risk of serious blood clots.

These clots can form inside certain blood vessels in your body, resulting in:

• deep vein thrombosis (DVT), which is a clot in your leg
• pulmonary embolism (PE), which is a clot in your lungs
• portal vein thrombosis, which is a clot in your liver (this condition is a possible risk if you already have chronic [long-term] liver disease)
• heart attack, which is caused by a clot that blocks blood supply to your heart muscle
• stroke, which is caused by a clot that blocks blood supply to your brain

In clinical trials, some adults who took Nplate for 1 year developed thrombocytosis. But it’s unclear how often blood clots occur in people who received Nplate.

For ITP, when you first start treatment with Nplate, your doctor will order a blood test for you each week to monitor your platelet count. They’ll adjust your dosage of Nplate based on the result of this test. This is how they’ll make sure your platelet count doesn’t get too high during treatment.

Once your platelet count and your Nplate dosage are both stable, your doctor will check your platelet count each month.

If you’re concerned about the risk of blood clots during Nplate treatment, talk with your doctor. They can discuss with you the risks and benefits of treatment.

Bone marrow changes

Using Nplate may increase the amount of reticulin in your bone marrow. (Reticulin is a type of connective tissue.)

Increased reticulin can sometimes progress into bone marrow fibrosis. With this condition, scar tissue develops in your bone marrow. But it’s not known for sure whether this condition happens with Nplate.

Depending on the condition being treated, you’ll have blood tests done regularly during Nplate treatment. If your blood tests show any problems with your blood cells, your doctor may want to check your bone marrow.

If certain tests show that the amount of reticulin is increasing in your bone marrow, your doctor may recommend that you stop receiving Nplate. This change in your bone marrow may improve after you stop Nplate treatment.

If you’re concerned about the risk of bone marrow changes with Nplate, talk with your doctor. They can discuss with you the risks and benefits of treatment.

Hair loss (not a side effect)

Hair loss is not a known side effect of Nplate. Clinical trials of Nplate did not report hair loss occurring.

If you have hair loss or you’re concerned about hair loss during Nplate treatment, talk with your doctor. They can recommend ways to help manage this side effect.

Nplate dosage

The Nplate dosage your doctor prescribes will depend on these factors:

• the condition being treated
• your body weight
• your platelet count, if you’re receiving Nplate to treat immune thrombocytopenia (ITP)

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, your doctor will determine the best dosage to fit your needs.

To learn more about Nplate’s dosage, see this article.

Drug forms and strengths

Nplate comes in single-dose vials that hold a powdered form of the drug. Nplate is available in three strengths: 125 micrograms (mcg), 250 mcg, and 500 mcg.

A healthcare professional will add liquid to the vials of Nplate to dissolve the powder. Then, they’ll give the medication to you as a subcutaneous injection.

Dosage for ITP

The typical dosage of Nplate for ITP in adults is one injection given each week.

For your first injection, the usual dose of Nplate is 1 mcg of drug per kilogram (kg) of body weight. One kilogram is equal to about 2.2 pounds (lb).

For the rest of your injections, your Nplate dose will be calculated based on your platelet counts.

During the start of your Nplate treatment, you’ll have a blood test to check your platelet count every week until your dosage is stable. (After your platelet count is stable, you will have monthly blood tests.) Your weekly Nplate dose will be increased by 1 mcg/kg each week until your platelet count is at least 50,000 platelets per microliter (mcL) of blood.

Until your platelet count is stable, your weekly dosage will be adjusted as follows:

• If your platelet count is lower than 50,000 platelets/mcL, your dosage will be increased by 1 mcg/kg.
• If your platelet count is between 200,000 and 400,000 platelets/mcL for 2 weeks in a row, your dosage will be reduced by 1 mcg/kg.
• If your platelet count is higher than 400,000 platelets/mcL, you won’t have a dose of Nplate that week. Instead, your platelet count will be checked every week until it falls below 200,000 platelets/mcL. At that point, you’ll start receiving Nplate again, but at a dosage that’s reduced by 1 mcg/kg.

Once your platelet count is stable at a level that’s right for you, your weekly dose of Nplate will stay the same. At this point, you will likely have a platelet count check only once per month.

The maximum weekly dosage of Nplate is 10 mcg/kg. However, most people reach and maintain stable platelet counts of about 50,000 platelets/mcL with a weekly dosage that’s lower than this. After 4 weeks of treatment at the maximum dose, if you don’t reach a platelet level that helps you avoid major bleeding, your doctor will recommend that you stop using Nplate.

Dosage for bone marrow syndrome

For bone marrow syndrome, the adult dosage is 10 mcg/kg given once. The drug should be given as soon as possible after exposure to radiation above a certain level.

It’s recommended that a healthcare professional administer the drug regardless of whether tests for blood cell levels can be done based on certain factors. These include a person’s estimated level of radiation exposure and whether they have certain symptoms.

Pediatric dosage

The dosage of Nplate to treat ITP in children is the same as it is for adults. For more information, see the “Dosage for ITP” section above.

Keep in mind that there’s one additional consideration for children’s Nplate dosing for ITP. Because they’re growing, children using the drug should be weighed every 12 weeks. This helps ensure that their dosage, which is based on their body weight, is correct over the course of treatment.

For bone marrow syndrome, the children’s dosage of Nplate is the same as it is for adults. For more information, see the “Dosage for bone marrow syndrome” section above.

What if I miss a dose?

If you’re taking Nplate for ITP and you miss an appointment to have your weekly injection, call your healthcare professional’s office as soon as possible. The medical staff will reschedule your appointment.

To help make sure that you don’t miss a dose, try setting a reminder on your phone.

Will I need to use this drug long term?

For ITP, Nplate is meant to be used as a long-term treatment. If you and your doctor determine that Nplate is safe and effective for you, you’ll likely use it long term. Your doctor may have you stop Nplate if your body does not make enough platelets after 4 weeks of treatment.

For bone marrow syndrome, Nplate is given as a one-time dose.

Nplate for ITP

The Food and Drug Administration (FDA) approves prescription drugs such as Nplate to treat certain conditions. Nplate is FDA-approved to treat immune thrombocytopenia, which is also called ITP. (This condition used to be called idiopathic thrombocytopenic purpura.)

For other uses of the drug, including off-label use, see the “Other uses of Nplate” section below. (Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.)

About ITP

With ITP, your immune system causes your spleen to destroy blood cells called platelets (also referred to as thrombocytes). These cells are needed to help your blood form clots. ITP causes you to have low levels of platelets, which means your blood is slow to clot. With ITP, you can bruise or bleed more easily than usual.

Common symptoms of ITP include purpura (many purple, brown, or black bruises on your skin or inside your mouth). Your bruises may also look more like a rash, made up of small, pinpoint-sized, red, purple, brown, or black dots.

Other common symptoms include nosebleeds, bleeding gums, and, in females, heavy periods. More serious internal bleeding is also possible.

Note: Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Nplate and ITP

Nplate works by stimulating your bone marrow to make more platelets. This reduces your risk of bleeding.

Nplate is approved to increase platelet counts in adults with ITP that hasn’t improved after treatment with either:

• corticosteroids (drugs used to lower the activity your immune system),
• immunoglobulin (a blood product that affects how your immune system works), or
• splenectomy (surgery to remove your spleen)

Nplate is also approved to increase platelet counts in certain children with ITP. For more information, see the “Nplate and children with ITP” section below.

Nplate is only FDA-approved to increase low platelet counts caused by ITP or bone marrow syndrome. It’s not approved to treat low platelet counts caused by any other condition.

Normal platelet counts are typically between 150,000 platelets per microliter (mcL) and 450,000 platelets/mcL.

Nplate is used to increase your platelet count to a level that helps lower your risk of bleeding. (This level is about 50,000 platelets/mcL.) The drug is not meant to bring your platelet count back to a normal level.

Nplate’s effectiveness for ITP

Clinical trials have found Nplate effective in increasing platelet counts and reducing the risk of bleeding in people with ITP. For details about these clinical trials, see Nplate’s prescribing information.

Nplate and children with ITP

Nplate is FDA-approved to increase platelet counts in children ages 1 year and older. It’s given to children who’ve had ITP for at least 6 months. For this use, the children’s ITP hasn’t responded to past treatment with either corticosteroids, immunoglobulins, or a splenectomy.

For more information about this use, see the “Nplate and ITP” section above.

Other uses for Nplate

The Food and Drug Administration (FDA) approves prescription drugs such as Nplate to treat certain conditions. Nplate is approved to treat immune thrombocytopenia (ITP) in certain people. (For details, see the “Nplate for ITP” section above.)

The FDA also approved Nplate to treat bone marrow syndrome. And the drug may be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Nplate for bone marrow syndrome

Nplate is FDA-approved to improve the survival of adults and children who have a type of radiation sickness called bone marrow syndrome. (Radiation sickness is also referred to as acute radiation syndrome.)

Exposure of most or all of a person’s body to high levels of radiation for a short period may cause radiation sickness. A possible result of radiation sickness is bone marrow syndrome, also referred to as hematopoietic syndrome. With this condition, bone marrow activity decreases, affecting the formation of blood cells such as platelets. In extreme cases, the condition can lead to infection and severe bleeding, and may even be fatal.

Early symptoms of radiation sickness include nausea and vomiting. Symptoms of bone marrow syndrome include loss of appetite, fever, and a general feeling of being unwell.

Nplate improves the survival of people with bone marrow syndrome by helping increase their levels of platelets. These cells help blood form clots, which reduces the risk of bleeding.

It’s recommended that Nplate be given as soon as possible after radiation exposure. A healthcare professional may administer the drug regardless of whether tests for blood cell levels can be done based on certain factors. These include a person’s estimated level of radiation exposure and whether they have certain symptoms.

The FDA’s approval of Nplate for bone marrow syndrome is based on results from animal studies as well as results of clinical trials of the drug for ITP. For more information, see Nplate’s prescribing information.

Off-label use for Nplate

Below is an example of off-label use of Nplate.

Nplate for aplastic anemia

Nplate isn’t FDA-approved to treat aplastic anemia. But the drug has been used off-label to increase platelet counts in people with aplastic anemia.

With this condition, your bone marrow doesn’t make enough new blood cells. Aplastic anemia causes low levels of all blood cell types (red blood cells, white blood cells, and platelets). The most common cause of aplastic anemia is a person’s immune system mistakenly attacking certain cells in their bone marrow.

Another medication in the same drug class as Nplate, eltrombopag (Promacta), is approved to increase platelet counts in people with aplastic anemia. (For a look at how Nplate compares with Promacta, see the “Nplate vs. Promacta” section below.)

A small 2019 study suggested that Nplate may be effective in increasing platelet counts in people with aplastic anemia. However, further research is needed.

If you have questions about treatment options for aplastic anemia, talk with your doctor.

Nplate for other uses in children

Nplate is FDA-approved to increase platelet counts in children ages 1 year and older who’ve had ITP for at least 6 months. It is also FDA-approved to improve the survival of children of any age who have bone marrow syndrome. (For more about these uses, see the “Nplate for ITP” and “Nplate for bone marrow syndrome” sections above.)

According to a 2019 study, Nplate has also been given off-label for other uses in a small number of children. For example, the drug has been used to increase platelet counts in children with the following conditions:

• ITP that’s been present for less than 6 months
• thrombocytopenia (low platelet count) that’s caused by chemotherapy or a bone marrow transplant
• neonatal alloimmune thrombocytopenia (a condition caused by a pregnant person’s immune system attacking the fetus’s platelets before birth)
• hereditary thrombocytopenia (a genetic disorder that causes low platelet counts)

More research is needed to know how effective Nplate is for these uses. If you have questions about using Nplate for any of these uses, talk with your or your child’s doctor.

Nplate use with other drugs

Nplate may be used with other routine treatments that are given for immune thrombocytopenia (ITP). In addition, rescue ITP treatments may sometimes be used along with Nplate.

For bone marrow syndrome, other drugs may be used for supportive care in addition to Nplate.

Nplate and routine ITP treatments

If you’re receiving Nplate for ITP, you may also need to take other routine ITP treatments, such as corticosteroids. Routine treatments are treatments that you use consistently over a period of time to treat your ITP. Corticosteroids are a class of drugs that lower the activity of your immune system. This action helps to stop your immune system from attacking your platelets.

For some people, receiving Nplate allows them to take a lower dose than usual of their other routine medications, such as corticosteroids. Or they may be able to stop using their routine medications altogether.

However, do not make any changes to your treatment plan unless your doctor recommends you do so.

Talk with your doctor about whether you’ll still need to use routine treatments while you’re receiving Nplate.

Nplate and rescue ITP treatments

If you’re receiving Nplate for ITP, you may need rescue treatments for your condition if your platelet count needs to be quickly increased. This situation could happen if you have severe bleeding that needs controlling or if you need to have surgery.

Rescue treatments include:

• platelet transfusion (receiving platelets taken from someone else’s body or from your body at an early point in time)
• intravenous* immunoglobulin,† called IVIg
• anti-D immunoglobulin†

* With intravenous (IV) infusion, the drug is injected into your vein over a period of time.
† Immunoglobulins are immune system proteins.

Talk with your doctor about whether you may need any rescue treatments during Nplate treatment.

Nplate and other treatments for bone marrow syndrome

If you’re receiving Nplate for bone marrow syndrome, you may need supportive treatments following radiation exposure. This can happen if you have particularly bad radiation burns or are at risk of infection.

Examples of such treatments include:

• antibiotics
• colony-stimulating factors (which help your body make more white blood cells), including:
  • filgrastim (Neupogen)
  • pegfilgrastim (Neulasta)
  • sargramostim (Leukine)
• stem cell transplant or platelet transfusion
• pain medications
• anti-nausea medications

How Nplate works

Nplate is used to treat immune thrombocytopenia (ITP). With this condition, your immune system mistakenly starts attacking certain cells in your body. It’s also used to treat bone marrow syndrome, which can decrease levels of blood cells, including platelets.

What happens with ITP and bone marrow syndrome

With ITP, your immune system starts to make antibodies (certain proteins) that attach to your platelets (a type of blood cell). Once antibodies mark the platelets, your spleen destroys the platelets. This lowers the number of platelets in your blood. With ITP, your immune system also reduces the number of platelets that your bone marrow usually makes.

Bone marrow syndrome is a type of radiation sickness. It can occur from exposure to high levels of radiation for a short period of time. This condition causes bone marrow activity to decrease, affecting the formation of platelets and other blood cells. In extreme cases, bone marrow syndrome can lead to infection and severe bleeding, and may even be fatal.

Platelets are essential for helping your body to form blood clots. For example, if a blood vessel is cut or damaged, platelets clump together to form a plug that helps stop the bleeding. Platelets also activate a chain reaction that ultimately forms a clot around the clump of platelets.

If you have low levels of platelets in your body, your blood is slow to form clots. And you can bruise and bleed more easily than usual.

What Nplate does

Nplate is a type of drug called a thrombopoietin receptor agonist. It works by increasing the number of platelets your bone marrow makes.

Bone marrow is a spongy substance inside your bones. And it’s the location where all of your blood cells are made. Different hormones in your body tell your bone marrow to make different types of blood cells.

For example, the hormone thrombopoietin (TPO) tells certain cells in your bone marrow to make platelets. TPO also tells your bone marrow to release the platelets into your bloodstream. The hormone does this by attaching to specific proteins called TPO receptors. These receptors are found on the surface of cells that make platelets.

Nplate mimics the effect of natural TPO in your body. Nplate attaches to and activates TPO receptors in the same way that the natural hormone does. This causes the platelet-making cells in your bone marrow to produce and release platelets.

How long does it take to work?

How long Nplate takes to work can vary from person to person. But for some people, Nplate may start to increase your platelet count after your first dose of the drug. (Note that for bone marrow syndrome, you’ll only receive one dose of the drug.) You’re unlikely to notice this, but certain blood tests will show that your platelet count has gone up.

How Nplate is administered

Nplate is given as a subcutaneous injection. Your doctor or a healthcare professional will administer the injection in a healthcare facility.

Subcutaneous injections are typically given in the following areas:

• your abdomen
• your upper arms
• your thighs

When it’s administered

For immune thrombocytopenia (ITP), you receive Nplate once per week, on the same day each week.

For bone marrow syndrome, you receive just one Nplate injection.

To help make sure that you don’t miss an appointment for your injection, try setting a reminder on your phone.

Alternatives to Nplate

Other drugs are available that can treat immune thrombocytopenia (ITP) or bone marrow syndrome. Some may be a better fit for you than others. If you’re interested in finding an alternative to Nplate, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed below are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Examples of drugs that may be used to treat ITP include:

• avatrombopag (Doptelet)
• eltrombopag (Promacta)
• fostamatinib (Tavalisse)
• prednisone (Rayos)
  • rituximab (Rituxan)
• intravenous* immunoglobulin† (IVIg)
• anti-D immunoglobulin†
• cyclophosphamide
• azathioprine (Imuran, Azasan)
• mycophenolate (CellCept)

* With intravenous (IV) infusion, the drug is injected into your vein over a period of time.
† Immunoglobulins are immune system proteins.

Examples of drugs that may be used to treat bone marrow syndrome include:

• filgrastim (Neupogen)
• sargramostim (Leukine)
• pegfilgrastim (Neulasta)
  

Nplate vs. Promacta

You may wonder how Nplate compares with other medications that are prescribed for similar uses. Here we look at how Nplate and Promacta are alike and different.

Ingredients

Nplate contains the active ingredient romiplostim, while Promacta contains the active ingredient eltrombopag. Both medications belong to a class of drugs called thrombopoietin receptor agonists.

Uses

Nplate and Promacta are both approved to increase platelet counts in people with immune thrombocytopenia (ITP). With this condition, your immune system mistakenly starts attacking your platelets. ITP can cause you to bleed and bruise more easily than normal.

These drugs are approved for use in adults with ITP that hasn’t improved after treatment with either:

• corticosteroids (drugs used to lower the activity of your immune system),
• immunoglobulin (a blood product that affects how your immune system works), or
• splenectomy (surgery to remove your spleen)

For this use, both Nplate and Promacta are also approved for use in children ages 1 year and older who’ve had ITP for at least 6 months.

In addition, each drug is approved for other uses.

Nplate may be used to improve the survival of adults and children from a type of radiation sickness called bone marrow syndrome. This condition can affect platelets and other blood cells.

Promacta is also approved to treat:

• Thrombocytopenia (low platelet count). For this use, Promacta is given to adults with chronic (long term) hepatitis C. The drug is prescribed to increase platelet counts both before and during treatment with another drug called interferon.
• Severe aplastic anemia. With this condition, your bone marrow doesn’t make enough new blood cells. For this use, Promacta can be given as first-line treatment* in combination with immunosuppressant drugs (drugs that lower the activity of your immune system). Or Promacta can be used for aplastic anemia that hasn’t improved with immunosuppressants in the past. Promacta is approved to treat severe aplastic anemia in adults and children ages 2 years and older.

* With first-line treatment, Promacta is the first drug given to treat the condition.

Drug forms and administration

Nplate is given as a subcutaneous injection. How often you receive the drug depends on the condition you are using it to treat. For ITP, a doctor or healthcare professional will administer the injection once per week in a healthcare facility.

On the other hand, Promacta comes as a tablet and as a powder that’s made into a suspension. You take these forms by mouth once per day.

It’s important to note that eltrombopag, the active ingredient in Promacta, is also available in some countries as the brand-name drug Revolade. However, Revolade hasn’t been approved for use in the United States.

Side effects and risks

Nplate and Promacta both contain a similar type of drug. These medications can cause some similar and some different side effects. Below are examples of these side effects.

Mild side effects

These lists contain examples of mild side effects that can occur with Nplate, with Promacta, or with both drugs (when used individually).

• Can occur with Nplate:
  • pain in your joints, shoulders, arms, or legs
  • abdominal pain
  • indigestion
  • dizziness
  • insomnia
  • bronchitis
  • sinus infection
  • cough
• Can occur with Promacta:
  • urinary tract infection (UTI)
  • increased liver enzymes (certain types of proteins)
  • rash
  • back pain
  • fatigue
• Can occur with both Nplate and Promacta:
  • upper respiratory infections, such as the common cold
  • nausea and vomiting
  • diarrhea
  • pain in your mouth and throat
  • headache
  • muscle pain
  • feeling pins and needles in your hands and feet

Serious side effects

These lists contain examples of serious side effects that can occur with Nplate, with Promacta, or with both drugs (when used individually).

• Can occur with Nplate:
  • new or worsening changes in your bone marrow
• Can occur with Promacta:
  • new or worsening liver problems*
  • cataracts (cloudiness in the lens of your eye)
• Can occur with both Nplate and Promacta:
  • blood clots
  • allergic reaction

* Promacta has a boxed warning for new or worsening liver problems. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Nplate and Promacta have different approved uses. But they’re both used to increase platelet counts in adults and children ages 1 year and older with ITP.

These drugs haven’t been directly compared in clinical trials. But 2018 reviews of studies in adults and studies in children found these drugs to be similarly effective in treating ITP.

In addition, a 2019 review of studies done in adults found Nplate to be slightly more effective than Promacta in treating ITP. But this review also found that Promacta was a reasonable alternative to Nplate.

Your doctor can recommend which of these drugs is a better option for your treatment.

Costs

Nplate and Promacta are both brand-name drugs.

Nplate is a biologic drug, which is made from living organisms. It is not currently available as a biosimilar. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). For more information, see the Nplate generic or biosimilar section above.

There is currently no generic form for Promacta.

Brand-name medications usually cost more than generics or biosimilars. The actual price you’ll pay for either Nplate or Promacta depends on your prescribed dosage and your insurance coverage.

Nplate vs. Doptelet

In addition to Promacta, other drugs are prescribed for uses similar to those of Nplate. Here we look at how Nplate and Doptelet are alike and different.

Ingredients

Nplate contains the active ingredient romiplostim, while Doptelet contains the active ingredient avatrombopag. Both medications belong to a class of drugs called thrombopoietin receptor agonists.

Uses

Nplate and Doptelet are both approved to increase platelet counts in people with immune thrombocytopenia (ITP). With this condition, your immune system mistakenly starts attacking your platelets. ITP can cause you to bleed and bruise more easily than normal.

These drugs are approved for use in adults with ITP that hasn’t improved with previous treatment. This may one of the following:

• corticosteroids (drugs used to lower the activity of your immune system)
• immunoglobulin (a blood product that affects how your immune system works)
• splenectomy (surgery to remove your spleen)

Nplate is also approved for this use in children ages 1 year and older who’ve had ITP for at least 6 months.

In addition, Nplate may be used to improve the survival of adults and children from a type of radiation sickness called bone marrow syndrome. This condition can affect platelets and other blood cells.

Doptelet is also approved to treat thrombocytopenia (low platelet count) in adults with chronic (long term) liver disease. For this use, the drug is given to increase platelet counts before certain procedures that have a risk of bleeding.

Drug forms and administration

Nplate is given as a subcutaneous injection. How often you receive the drug depends on the condition it’s used to treat. For ITP, a doctor or healthcare professional will administer the injection once per week in a healthcare facility.

Doptelet, on the other hand, comes as a tablet that you take by mouth once per day.

Side effects and risks

Nplate and Doptelet both contain a similar type of drug. These medications can cause very similar side effects. Below are examples of these side effects.

Mild side effects

These lists contain examples of mild side effects that can occur with Nplate, with Doptelet, or with both drugs (when used individually).

• Can occur with Nplate:
  • pain in your muscles, shoulders, arms, or legs
  • abdominal pain
  • indigestion
  • dizziness
  • feeling pins and needles in your hands and feet
  • insomnia
  • cough
  • bronchitis
  • sinus infection
  • nausea and vomiting
  • diarrhea
  • pain in your mouth and throat
• Can occur with Doptelet:
  • fatigue
  • bruising
  • nosebleeds
  • bleeding gums
• Can occur with both Nplate and Doptelet:
  • headache
  • upper respiratory infections, such as the common cold
  • joint pain

Serious side effects

These lists contain examples of serious side effects that can occur with Nplate, or with both Nplate and Doptelet (when used individually).

• Can occur with Nplate:
  • new or worsening changes in your bone marrow
• Can occur with Doptelet:
  • no unique serious side effects
• Can occur with both Nplate and Doptelet:
  • blood clots
  • allergic reaction

Effectiveness

Nplate and Doptelet have different FDA-approved uses, but they’re both used to increase platelet counts in adults with ITP.

These drugs haven’t been directly compared in clinical trials. One 2019 review of studies found Nplate to be slightly more effective in treating ITP than Doptelet. But this review also found that Doptelet was a reasonable alternative to Nplate.

Your doctor can recommend which of these drugs is a better fit for you.

Costs

Nplate and Doptelet are both brand-name drugs.

Nplate is a biologic drug, which is made from living organisms. It is not currently available as a biosimilar. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). For more information, see the Nplate generic or biosimilar section above.

There is currently no generic form for Doptelet.

Brand-name medications usually cost more than generics or biosimilars. The actual price you’ll pay for either Nplate or Doptelet depends on your dosage and your insurance coverage.

Nplate and alcohol

Alcohol hasn’t been reported to interact with Nplate. However, regularly drinking large amounts of alcohol can cause low platelet counts. Nplate is used to treat immune thrombocytopenia (ITP), which is a condition that also causes low platelet counts.

Talk with your doctor about whether it’s safe for you to drink alcohol during Nplate treatment.

Nplate interactions

There aren’t any medications, herbs, or supplements that have been reported to interact with Nplate.

Drug interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

However, before starting Nplate, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Nplate cost

As with all medications, the cost of Nplate can vary.

The actual price you’ll pay will depend on your insurance plan, your location, and the medical facility where you receive Nplate.

If you have insurance, your insurance company may require you to get prior authorization before it approves coverage for Nplate. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know whether your plan will cover Nplate.

If you’re not sure whether you’ll need to get prior authorization for Nplate, contact your insurance plan.

To find out more about Nplate and cost, see this article.

Financial and insurance assistance

If you need financial support to pay for Nplate, or if you need help understanding your insurance coverage, help is available.

Amgen, the manufacturer of Nplate, offers a program called Amgen Support that can help provide information to you about the cost and financial assistance available for Nplate. For more information and to find out if you’re eligible for support, call 866-264-2778 or visit the program website.

Nplate and pregnancy

It is unknown whether Nplate is safe to receive during pregnancy. Studies of Nplate in pregnant animals found that the drug can harm fetuses when used during pregnancy. However, animal studies don’t always predict what will happen in humans.

It’s also important to note that if your platelet count is very low toward the end of pregnancy, you have an increased risk of severe bleeding during or after childbirth. Nplate is used to treat immune thrombocytopenia (ITP), which causes low platelet counts.

If you’re pregnant or planning to become pregnant, talk with your doctor about the possible risks and benefits of using Nplate.

Nplate and birth control

It is unknown whether Nplate is safe to receive during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Nplate.

Nplate and breastfeeding

It is not known for sure whether Nplate passes into breast milk. However, because the drug can possibly cause serious side effects in a child who’s breastfed, you should not breastfeed while receiving it.

If you’re breastfeeding, talk with your doctor about safe and healthy ways to feed your child while you’re receiving Nplate.

Common questions about Nplate

Here are answers to some frequently asked questions about Nplate.

Will I have to change my diet while I’m using Nplate?

No, you should not need to change your diet. The manufacturer of Nplate hasn’t recommended any dietary restrictions during Nplate treatment. In fact, food doesn’t affect the way Nplate works in your body.

During Nplate treatment, you should be able to continue with your usual diet unless your doctor recommends otherwise.

Does Nplate cure ITP?

No, Nplate doesn’t cure immune thrombocytopenia (ITP). Because Nplate doesn’t remove the cause of ITP, it can’t cure the condition. However, you can use Nplate long term to help manage the condition. Nplate does this by increasing your platelets to a stable level that reduces your risk of bleeding.

Is Nplate a steroid?

No, Nplate isn’t a steroid. Steroids (also called corticosteroids) are medications that lower the activity of your immune system. Steroids can be used for ITP to help stop your immune system from attacking your platelets. (With ITP, your immune system attacks your platelets and leads to low platelet counts.)

However, Nplate is a different type of drug. It’s called a thrombopoietin receptor agonist. Nplate works to treat ITP by stimulating your bone marrow to make more platelets.

How often will I need to have lab tests done while I’m receiving Nplate?

This depends on what condition you are using Nplate to treat.

For bone marrow syndrome, the manufacturer does not provide recommendations for lab tests.

For ITP, when you first start treatment with Nplate, you’ll need to have blood tests done every week. Your doctor will order a test called a complete blood count (CBC). This test lets your doctor check the levels of all your blood cells, including platelets.

Your doctor will adjust your weekly Nplate dosage based on your platelet counts. When your platelet count and weekly Nplate dosage are both stable, you’ll have blood tests once per month.

Once you’ve completed Nplate treatment, you’ll need to have weekly blood tests for 2 weeks. This is done to make sure that your platelet count doesn’t drop too low after you stop using the drug.

If you have questions about the lab tests you’ll need during Nplate treatment, talk with your doctor.