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What Is Nplate?

Nplate is a medication that is in the form of a subcutaneous injection typically prescribed to treat immune thrombocytopenia (a condition characterized by low platelet count) in adults and pediatric patients when previous treatments like corticosteroids, splenectomy, or immunoglobulins do not give promising results.

This branded medication was first approved by the FDA in 2008 and is also known by its generic name, “romiplostim.” Nplate belongs to the class of thrombopoietin receptor agonists (drug agents that stimulate platelet production).

Nplate is only available in a branded form and comes in single-dose vials of different strengths.

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What Is Nplate Used To Treat?

Nplate is indicated to treat immune thrombocytopenia (ITP), an autoimmune condition in which a patient’s immune system produces autoantibodies that mistakenly attack and destroy the platelets, resulting in a low platelet level in the blood.

Platelets are a type of blood cell produced by the bone marrow and circulate in the blood. Normally, these cells aggregate (stick together) during injury or cuts to seal the damaged blood vessels and limit excess blood loss.

However, in ITP, the patient’s body experiences trouble stopping bleeding due to low platelet counts, which eventually increases the risk of severe internal or external bleeds or bruising.

Nplate is used to keep the platelet count at least at or above 50,000/µL to prevent bleeding episodes or bruises associated with ITP. The FDA has only approved Nplate to treat low platelet counts caused by ITP, not by other medical conditions such as myelodysplastic syndrome (MDS).

In some cases, Nplate is also used to increase the survival rate in patients whose bone marrow has been affected due to exposure to myelosuppressive (suppressing the bone marrow) doses of radiation.

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Nplate Dosing Information

The dose of Nplate is calculated according to the patient’s weight. The dose can then be adjusted according to the response to the treatment and platelet count (targeting to maintain platelet count at or above 50,000/mm3) as necessary to reduce the risk of bleeding.

Nplate should not be used to normalize platelet counts.

For Adults and Pediatrics With ITP

The initial dose of Nplate is calculated according to the actual body weight of an adult or pediatric patient. The initial dose is 1 mcg/kg given once a week.

After the initial dose, future doses are adjusted according to the platelet count. The weekly dose is adjusted with increments of 1 mcg/kg until the patient (adult/pediatric) achieves a platelet count of 50,000/mm3 or greater.

The maximum weekly doses should not exceed 10 mcg/kg.

For Adult and Pediatric Patients with Hematopoietic Syndrome of Acute Radiation Syndrome (HSARS)

Adult and pediatric patients, including neonates with HSARS, receive one dose of 10 mcg/kg as a subcutaneous injection immediately after exposure to radiation.

Nplate Side Effects

Like all medications, Nplate may cause some side effects. 

The most common side effects (affecting more than 1 in 10 patients) in adults with ITP include:

  • Headache and dizziness
  • Allergic reaction (swelling, itching, rashes)
  • Upper respiratory tract infections
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The most common side effects reported in children and adolescents with ITP include:

  • Nose and throat infection (upper respiratory tract infections)
  • Diarrhea and abdominal pain
  • Runny nose, cough, and fever
  • Rash and bruising
  • Mouth and throat pain
  • Pyrexia
  • Oropharyngeal pain
  • Contusion

The less common or adverse side effects (affecting up to 1 in 100 patients) you may experience after taking Nplate include:

  • Thrombotic/thromboembolic complications due to high platelet levels
  • Progression of MDS (myelodysplastic syndrome)
  • Bone marrow failure due to reticulin fiber formation within the bone marrow
  • Muscle tightness, muscle weakness
  • Loss of response to Nplate
  • A condition called erythromelalgia (a rare condition that causes episodes of burning pain and redness in the feet and sometimes the hands, arms, legs, ears, and face)

These are not all the possible side effects that might be caused by Nplate. Speak to your doctor or pharmacist for more information.

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