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Nplate

romiplostim
Used for Chronic ITP
Used for Chronic ITP

Nplate (romiplostim) is injected under the skin weekly mainly to treat low platelet counts in people whose immune system attacks their platelets. Unlike some other medications used to treat this condition, Nplate (romiplostim) doesn't weaken the immune system, so it doesn’t raise your risk for infections. Nplate (romiplostim) is only used when certain medical procedures (removal of the spleen or splenectomy) or other medications for ITP (corticosteroids) haven't worked well for you.

Reviewed by:
reviewer
Lilytt Grigorian
reviewer
Connie Zheng, PharmD
reviewer
Cydnee Ng, PharmD
Last reviewed on May 25, 2022
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostAlternativesLatest newsPricesMedicare
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What is Nplate (romiplostim)?

What is Nplate (romiplostim) used for?

How Nplate (romiplostim) works

Nplate (romiplostim) is a thrombopoietin receptor agonist. This means that it acts like the hormone thrombopoietin that’s responsible for the production of your platelets. Platelets are blood cells that help you form clots to prevent bleeds. When your platelet levels are too low, you’re at higher risk for bleeds.

Nplate (romiplostim) is used to raise the amount of platelets in people with immune thrombocytopenia, a condition where your platelets are attacked by your immune system. Nplate (romiplostim) is also used to raise platelet levels in people whose platelets have been destroyed by too much radiation exposure. By raising the platelet levels, this medication helps lower the risk for bleeding.

Drug Facts

Common BrandsNplate
Drug ClassThrombopoietin receptor agonist
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Nplate (romiplostim)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Adults:
  • Joint stiffness (26%)
  • Dizziness (17%)
  • Trouble sleeping (16%)
  • Muscle pain (14%)
  • Arm or leg pain (13%)
  • Stomach pain (11%)
Children:
  • Bruising (41%)
  • Cough, runny nose, and other symptoms of an upper respiratory tract infection (31%)
  • Mouth and throat pain (25%)
  • Fever (24%)
  • Diarrhea (20%)
  • Rash (15%)
  • Stomach pain (14%)

Other Side Effects

Adults:
  • Shoulder pain
  • Heartburn
  • Tingling sensation in the arms, legs, hands, or feet
Children:
  • Purple spots on the skin (from damaged small blood vessels)
  • Swelling in the arms and legs
  • Hives
  • Ear, stomach, and sinus infection, redness, or swelling

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin with or without fever, wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
  • Blood clot in the liver: upper stomach pain, nausea, vomiting, diarrhea
  • Other types of blood clots: legs or arms (swelling, redness, pain), lungs (difficulty breathing, chest pain), heart attack (chest pain, pain in the arms or shoulders, pain in the neck or jaw, shortness of breath), stroke (numbness, tingling feeling, difficulty speaking, confusion)

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Bloating or swelling of the face, arms, hands, lower legs, or feet

body aches or pain

change in hearing

chills

cough

diarrhea

difficulty breathing

ear congestion, drainage, or pain

fever

headache

loss of appetite

loss of voice

nausea

pain or tenderness around the eyes and cheekbones

rapid weight gain

sneezing

sore throat

stomach pain

stuffy or runny nose

tightness of the chest

tingling of the hands or feet

unusual tiredness or weakness

unusual weight gain or loss

upper stomach pain

Incidence not known

Burning pain, warmth, swelling, or redness of the hands and feet

fast heartbeat

feeling of warmth

hives, itching, skin rash

hoarseness

irritation

joint pain, stiffness, or swelling

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals

redness of the skin

trouble swallowing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Acid or sour stomach

belching

bruise

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

difficulty with moving

dizziness

heartburn

indigestion

mouth or throat pain

muscle pains, cramps, or stiffness

pain in the shoulder, arms, or legs

stomach discomfort, upset, or pain

trouble sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Nplate (romiplostim)

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Pros

Only injected once a week

No risk of serious infection since it doesn’t weaken the immune system, like corticosteroids

Can be used in children

Patient assistance programs are available to help lower the cost

thumbs-down

Cons

Needs to be injected, so not a good option for people who don’t like needles

Has to be injected by a provider at a hospital or clinic

Risk of blood clots

Only available as a brand medication, so it can be expensive

pharmacist-tips

Pharmacist tips for Nplate (romiplostim)

pharmacist

  • When you first begin Nplate (romiplostim), your healthcare provider will monitor and check your platelet levels every week to see if the dose is right for you and change your dose if needed. Once you’re on a stable dose of Nplate (romiplostim), you’ll only need to get blood tests once a month.

    • If you miss an appointment for your Nplate (romiplostim) injection, call your provider as soon as possible to schedule your next dose.

      • If your provider thinks your platelet levels are stable enough for you to stop taking Nplate (romiplostim), you’ll still have to continue getting blood tests for at least 2 weeks after your last dose to make sure your platelet counts haven't dropped.

        • Talk with your provider if you have any bruising, bleeding, or swelling after receiving the Nplate (romiplostim). Be careful when playing contact sports, shaving, or using sharp objects. There’s a chance that Nplate (romiplostim) might not work well for you, so you might still be at risk for bleeds.

          • Nplate (romiplostim) shouldn't be used during pregnancy or breastfeeding because there’s a possibility that it can harm the baby.

            • Nplate (romiplostim) (romiplostim) might raise the risk of blood clots. Let your provider know if you experience any swelling, redness, or pain.

              faqs

              Frequently asked questions about Nplate (romiplostim)

              What is immune thrombocytopenic purpura (ITP)?
              ITP is a medical condition where your immune system, which protects your body from infections, attacks your platelets instead. Platelets are small blood cells that help the blood clot. When your immune system attacks your platelets, it lowers the amount of platelets in your body. And when your platelet levels are too low, you’re at higher risk for serious bleeds. Nplate (romiplostim) raises the amount of platelets in your body to lower your risk of bleeding and bruising from ITP.
              What are some symptoms of ITP?
              If you have ITP, your symptoms typically depend on how low your platelet levels are and the location of your bleed. Some people who have mild ITP might not experience any symptoms. And some people who have severely low platelet counts might have bleeding on the inside of their body that’s not very noticeable. Common symptoms of bleeds can include small red dots on the skin, purple spots on the skin, and bruising on the arms and legs from minor bumps. If you have ITP, be careful during activities that might cause injury or bruising, such as contact sports. Use caution when shaving, brushing your teeth, or using sharp objects.
              Is Nplate (romiplostim) a first-choice option for ITP?
              Corticosteroids, not Nplate (romiplostim), are typically the first-choice options in people with ITP. If the corticosteroids don’t work well for you, your provider might consider switching you to a second-choice treatment option, such as Nplate.
              How will my provider check to see if Nplate (romiplostim) is safe and working well for me?
              Your provider will measure your platelet levels every week to find a dose of Nplate (romiplostim) that works well for you. Your provider will start you at a low dose in the beginning and then raise it over time. Keep in mind that Nplate (romiplostim) isn't used to bring your platelets to the same level as someone without ITP. Instead, it raises your platelet levels just high enough to lower your risk of bleeding. And if your platelet levels remain steady, your provider might even be able to stop your ITP treatments for some time.
              Does Nplate (romiplostim) put me at risk for clots?
              Yes, Nplate (romiplostim) can put you at risk for clots. This medication works by raising the level of platelets in your body. But if your platelet level is too high, you can get blood clots. Let your provider know if you have any liver problems before starting Nplate (romiplostim). Some people who have liver problems developed a clot in their liver while taking this medication. It’s also possible for a clot to develop anywhere in your body, such as your heart or brain, and cause a heart attack or a stroke. Call your provider right away if you experience symptoms of a clot in your liver (nausea, vomiting, fevers, chills) or clots in other parts of your body (swelling of the arms, legs, or stomach).
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              What are the risks and warnings for Nplate (romiplostim)?

              Nplate (romiplostim) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Blood cancer (leukemia)

              People with MDS who use Nplate (romiplostim) can develop a more serious blood cancer called acute myeloid leukemia (AML). As a result, Nplate (romiplostim) is not approved to treat low platelet levels in people with MDS. Before starting Nplate (romiplostim), speak to your provider if you have a history of blood cancer because this medication might not be right for you.

              risk-warning

              Blood clots

              • Risk factors: Liver problems | History of blood clots

                Because Nplate (romiplostim) raises your platelet levels, it can put you at higher risk for blood clots. Blood clots linked to Nplate (romiplostim) use were those that occurred in the liver (portal vein thrombosis) in people with liver problems. Let your healthcare provider know if you experience symptoms of a clot in your liver, including stomach pain, nausea, vomiting, or diarrhea.

                It’s also possible for clots to form in other parts of your body, like your heart or brain. This can cause problems such as a heart attack or stroke. If you experience chest pain, pain in the arms or shoulders, redness or swelling in the arms or legs, numbness on one side of your body, difficulty breathing, or confusion, contact your provider as soon as possible.

                risk-warning

                Possibility that Nplate (romiplostim) doesn't work well for you

                • Risk factors: Antibodies against Nplate (romiplostim)

                  Nplate (romiplostim) might not work well for everyone. It's possible for some people to develop antibodies that block Nplate (romiplostim) from working. Let your provider know if you continue to notice signs of bleeding, such as bruising easily or bleeds that are difficult to stop, even though you've been taking Nplate (romiplostim) for a while. Your provider might need to test you for antibodies.

                  dosage

                  Nplate (romiplostim) dosage forms

                  Typical dosing for Nplate (romiplostim)

                  This medication must be given by a healthcare provider. Your provider will determine your dose of Nplate (romiplostim) based on your weight.

                  • ITP: The typical starting dose is 1 mcg/kg injected under the skin once weekly. Your provider will adjust your dose based on your platelet level.

                  • Blood problems from too much radiation: The typical dose is 10 mcg/kg injected under the skin as a one-time dose by your provider.

                  interactions

                  Interactions between Nplate (romiplostim) and other drugs

                  Nplate (romiplostim) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Nplate (romiplostim). Please note that only the generic name of each medication is listed below.

                  Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

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                  How much does Nplate (romiplostim) cost?

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                  Nplate (brand)
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                  alternatives

                  What are alternatives to Nplate (romiplostim)?

                  There are a number of medications that your doctor can prescribe in place of Nplate (romiplostim). Compare a few possible alternatives below.
                  Nplate (romiplostim)
                  Used for:
                  $10073.49 Lowest GoodRx priceView Prices
                  Prednisone
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                  Promacta (eltrombopag)
                  Used for:

                  • Low platelet count in people with immune thrombocytopenic purpura (ITP) when other medications haven’t worked - adults and children

                  • Low platelet count in people with long-term hepatitis C - adults only

                  • Used alone or with other medications in people who can’t make enough blood cells (severe aplastic anemia) - adults and children

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