Classification: Thrombopoietin Receptor Agonists
About Romiplostim (Nplate®)
Romiplostim is a man-made protein medicine used to treat low blood platelet counts (thrombocytopenia) in adults with chronic idiopathic thrombocytopenic purpura (ITP). Romiplostim works by causing the cells in the bone marrow to produce more platelets. It should not be used to treat thrombocytopenia caused by other conditions and may worsen pre-existing blood cancers or myelodysplastic syndrome (MDS).
How to Take Romiplostim
Romiplostim is given as a subcutaneous injection (given under the skin) once a week. The dose is based on your body size and platelet count. Your platelet count will be checked each week and the dose of medication adjusted accordingly.
Possible Side Effects of Romiplostim
There are a number of things you can do to manage the side effects of romiplostim. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Bone Marrow Changes
Long-term use of romiplostim may cause changes in your bone marrow. These can include an increase in reticulin. Increased reticulin is unlikely to cause problems, but it is not known if this can lead to a more serious condition called bone marrow fibrosis, which is a scarring of the bone marrow, causing it to produce fewer blood cells. Your healthcare provider will monitor your blood tests for abnormalities that could signify changes in the bone marrow.
Muscle or Joint Pain/Aches and Headache
Your doctor or nurse can recommend medication and other strategies to relieve pain.
Your healthcare provider will monitor your platelet count to attempt to prevent it from getting too high. A high platelet count can increase the risk of developing a blood clot. Blood clots can occur anywhere in the body, but occur most frequently in the calves (leg) or the lungs. People at higher risk for developing blood clots include those with a family history of blood clots, smokers, those who have an inactive lifestyle, older patients, and those with other medical problems.
Signs of a blood clot in the leg may include any of the following: leg pain, warmth, swelling of one leg more than the other. Signs of a blood clot in the lung could include: fever, shortness of breath that comes on you very quickly, racing heart, chest pain (that tends to be worse when you take a deep breath).
If you have any of these signs or symptoms of blood clots, you will need to be seen immediately so that you can be treated with blood thinners. Call your doctor or nurse or go to the emergency room.
Low Platelet Count After Stopping the Medication
In clinical trials, some patients experienced lower platelet counts when the medication was stopped than they had before taking the medication. This side effect is most likely to occur shortly after stopping romiplostim and may last about 2 weeks. This lower platelet count increases the risk of bleeding, so precautions should be taken and any bruising or bleeding should be reported to your healthcare provider.
Other Side Effects
Some less common side effects that have been reported include: dizziness, indigestion, insomnia, and tingling in the hands and feet. Notify your provider of any of these side effects.
This medication can lead to worsening changes in the function of your bone marrow. Your provider may need to check your bone marrow during treatment with this medication.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and if you become pregnant notify your provider. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.