৳ 357.14/unit
Pack: ৳ 9,999.92
৳ 357.14/unit
Pack: ৳ 9,999.92
At a glance
Avatrombopag is a thrombopoietin receptor agonist (TPO-RA) used for the treatment of thrombocytopenia in patients with chronic liver disease (CLD) or chronic immune thrombocytopenia (ITP).
Indications
- Thrombocytopenia in patients with chronic liver disease who are scheduled to undergo a procedure
- Thrombocytopenia in patients with chronic immune thrombocytopenia who have had insufficient response to previous treatment
Pharmacology
Avatrombopag is an orally bioavailable, small molecule TPO receptor agonist that stimulates proliferation and differentiation of megakaryocytes from bone marrow progenitor cells resulting in increased platelet production. Avatrombopag does not compete with TPO for binding to the TPO receptor and has an additive effect with TPO on platelet production.
Avatrombopag results in dose- and exposure-dependent elevations in platelet counts. Platelet count increase is observed within 3-5 days of starting a 5-day course, with peak effect at 10-13 days. Platelet counts return to near baseline after 35 days.
Dosage
Chronic Liver Disease (CLD) - Pre-procedure:
- Platelet count <40 × 10⁹/L: 60 mg (3 tablets) once daily for 5 days with food
- Platelet count 40 to <50 × 10⁹/L: 40 mg (2 tablets) once daily for 5 days with food
- Initiate dosing 10-13 days prior to procedure; perform procedure 5-8 days after last dose
Chronic Immune Thrombocytopenia (ITP):
- Initial dose: 20 mg (1 tablet) once daily with food
- Dose level adjustments (based on platelet count):
- <50 × 10⁹/L after ≥2 weeks: Increase 1 dose level
- 200-400 × 10⁹/L: Decrease 1 dose level
- >400 × 10⁹/L: Stop Avatrombopag; monitor twice weekly
ITP Dose Levels: Level 6: 40 mg/day; Level 5: 40 mg 3x/week + 20 mg remaining 4 days; Level 4: 20 mg/day; Level 3: 20 mg 3x/week; Level 2: 20 mg 2x/week OR 40 mg weekly; Level 1: 20 mg weekly
Side effects
Chronic Liver Disease (CLD):
- Pyrexia (8-11%)
- Abdominal pain (6-7%)
- Nausea (6-7%)
- Headache (4-7%)
- Fatigue (3-4%)
- Peripheral edema (3-4%)
Chronic ITP:
- Headache, fatigue, confusion, epistaxis, upper respiratory tract infection, arthralgia, gingival bleeding, petechiae, nasopharyngitis
Rare (<1%): Hyponatremia (0.7%)
Use in pregnancy
[CONSULT YOUR DOCTOR] Pregnancy Category C. Animal studies showed adverse developmental outcomes during organogenesis. Advise pregnant women of potential risk to the fetus.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Precautions & warnings
Serious Precautions:
- TPO receptor agonists are associated with thrombotic and thromboembolic complications
- Portal vein thrombosis reported in patients with chronic liver disease
- Caution in patients with known risk factors for thromboembolism (Factor V Leiden, Prothrombin 20210A, Antithrombin deficiency, Protein C or S deficiency)
- Do not use in an attempt to normalize platelet counts
- Monitor for signs and symptoms of thromboembolic events
- May cause fetal harm during pregnancy
- Breastfeeding not recommended during treatment and for 2 weeks after the last dose
Overdose effects
Overdose may cause excessive platelet count increase and thrombotic/thromboembolic complications. Monitor patient and platelet count. Treat thrombotic complications per standard of care. No specific antidote. Hemodialysis is not expected to enhance elimination (only ~6% renally excreted, highly protein-bound).
Storage conditions
Keep below 30°C, away from light and moisture. Keep out of reach of children.