avatrombopag

General

Pronunciation:
a-va-trom-boe-pag

Trade Name(s)

  • Doptelet

Ther. Class.
antithrombocytopenics

Pharm. Class.
thrombopoietin receptor agonists

Indications

Treatment of thrombocytopenia in patients with chronic liver disease who are scheduled to undergo a medical or dental procedure.

Action

Increases platelet production by initiating proliferation and differentiation of megakaryocytes from bone marrow progenitor cells.

Therapeutic Effect(s):

  • Increased platelet counts.
  • Decreased requirement for platelet transfusions or rescue procedures for bleeding.

Pharmacokinetics

Absorption: 66–69% absorbed following oral administration.

Distribution: Widely distributed to tissues.

Protein Binding: >96%.

Metabolism and Excretion: Primarily metabolized by CYP2C9 and CYP3A4 isoenzymes; primarily eliminated in feces (34% as unchanged drug).

Half-life: 19 hr.

TIME/ACTION PROFILE (effect on platelet count)

ROUTEONSETPEAKDURATION
PO3–5 days10–13 days2 wk

Contraindication/Precautions

Contraindicated in:

  • OB: Pregnancy (may cause fetal harm)
  • Lactation: Avoid breastfeeding.

Use Cautiously in:

  • Factor V Leiden, prothrombin 20210A, antithrombin deficiency or protein C or S deficiency (↑ risk for thromboembolism)
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

CNS: fatigue, headache

CV: THROMBOEMBOLISM, peripheral edema

F and E: hyponatremia

GI: abdominal pain, nausea

Hemat: anemia

MS: myalgia

Misc: fever

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None known.

Route/Dosage

PO (Adults) Platelet count <40 x 109/L–60 mg once daily for 5 days (should be initiated 10–13 days prior to scheduled procedure; procedure should be performed 5–8 days after last dose); Platelet count 40–<50 x 109/L–40 mg once daily for 5 days (should be initiated 10–13 days prior to scheduled procedure; procedure should be performed 5–8 days after last dose.

Availability

Tablets: 20 mg

Assessment

  • Monitor for signs and symptoms of thromboembolism (leg swelling, pain, or tenderness; tachycardia; dyspnea; abdominal pain or tenderness; chest pain) during and following therapy.

Lab Test Considerations:

Obtain platelet count before starting therapy and on day of procedure to make sure platelet count is adequate.

Potential Diagnoses

Implementation

  • Begin dosing 10–13 days prior to procedure. Schedule procedure for 5–8 days after last dose.
  • PO Administer daily for 5 days with food.

Patient/Family Teaching

  • Instruct patient to take avatrombopag as directed. Take missed dose as soon as remembered; do not take two doses in the same day. Take next dose as scheduled; complete all 5 days of dosing.
  • Rep: May be teratogenic. Advise women of childbearing potential to use effective contraception during therapy and to avoid breastfeeding during and for 2 wks after last dose of avatrombopag. A lactating woman should pump and discard breast milk during this period.

Evaluation/Desired Outcomes

Decreased requirement for platelet transfusions or rescue procedures for bleeding.

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