Romiplostim (brand name Nplate®) and Eltrombopag (brand name Promacta®/Revolade®) are thrombopoietin receptor agonists (TPO-RAs) used to stimulate platelet production in patients with thrombocytopenia. While romiplostim is a peptide-based injectable drug, eltrombopag is an oral non-peptide agent. Both are primarily used in immune thrombocytopenia (ITP) and other conditions with low platelet counts.
Storage
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Romiplostim: Store refrigerated at 2–8°C; protect from light. Do not freeze or shake.
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Eltrombopag: Store at room temperature (20–25°C) in a dry place. Keep the tablets in their original packaging.
Use
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Primary Indication: Chronic immune thrombocytopenia (ITP) in patients who have had an insufficient response to corticosteroids or immunoglobulins.
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Other Uses:
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Eltrombopag: Aplastic anemia, hepatitis C-associated thrombocytopenia.
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Romiplostim: Chemotherapy-induced thrombocytopenia (under investigation).
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Clinical Significance
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Increases platelet counts, reducing bleeding risk.
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Reduces dependency on corticosteroids or platelet transfusions.
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Improves quality of life in chronic ITP patients.
Drawbacks
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High cost (expensive long-term therapy).
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Requires regular monitoring of platelet counts (risk of thrombosis if overcorrected).
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Not curative—discontinuation may lead to platelet drop.
Side Effects
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Common: Headache, fatigue, dizziness, nausea (eltrombopag), injection-site reactions (romiplostim).
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Serious:
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Thrombosis (due to excessive platelet increase).
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Bone marrow fibrosis (with long-term use).
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Hepatotoxicity (eltrombopag—requires liver function monitoring).
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Conclusion
Romiplostim and eltrombopag are effective in managing chronic ITP and other thrombocytopenic conditions by stimulating platelet production. While they reduce bleeding risk and improve patient outcomes, their use requires careful monitoring due to potential thrombotic risks and side effects. They serve as valuable alternatives for patients unresponsive to conventional therapies.
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