thrombopoietin receptor agonists
Treatment of thrombocytopenia in patients with chronic liver disease who are scheduled to undergo a medical or dental procedure.
Increases platelet production by initiating proliferation and differentiation of megakaryocytes from bone marrow progenitor cells.
- Increased platelet counts.
- Decreased requirement for platelet transfusions or rescue procedures for bleeding.
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)
|PO||3–5 days||10–13 days||2 wk|
- 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
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
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.
Tablets: 20 mg
- 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.
- Deficient knowledge, related to medication regimen (Patient/Family/Teaching)
- 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.
- 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.
Decreased requirement for platelet transfusions or rescue procedures for bleeding.
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