General

Genetic Implications:

Pronunciation:
loo-soo-trom-boe-pag

Trade Name(s)

• Mulpleta

Ther. Class.

antithrombocytopenics

Pharm. Class.

thrombopoietin receptor agonists

Indications

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

Action

Acts as a thrombopoietin receptor agonist which increases platelet production by initiating proliferation and differentiation of megakaryocytes from bone marrow progenitor cells.

Therapeutic Effect(s):

• Reduction in need for platelet transfusions prior to procedure.
• Reduction in need fore rescue therapy for bleeding after procedure.
• Increased platelet count.

Pharmacokinetics

Absorption: Unknown.

Distribution: Well distributed to tissues.

Protein Binding: >99%.

Metabolism and Excretion: Primarily metabolized in liver via CYP4 isoenzymes. Primarily excreted in feces (83%) with 16% being eliminated as unchanged drug.

Half-life: 27 hr.

TIME/ACTION PROFILE (plasma concentrations)

Contraindication/Precautions

Contraindicated in:

• Lactation:  Lactation.

Use Cautiously in:

•  Risk factors for thromboembolism (Factor V Leiden, Prothrombin 20210A, Antithrombin deficiency, Protein C or S deficiency);
• OB:   Safety not established in pregnancy;
• Pedi:   Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

CV: THROMBOEMBOLISM

GI: PORTAL VEIN THROMBOSIS

Neuro: headache

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

Interactions

Drug-Drug

None reported.

Route/Dosage

Should not be used in patients with chronic liver disease to normalize platelet counts.

PO (Adults): 3 mg once daily for 7 days. Begin therapy 8–14 days prior to the scheduled procedure such that the procedure takes place 2–8 days after the final dose.

Availability

Tablets: 3 mg

Assessment

• Monitor for headache during therapy.

Lab Test Considerations:

Obtain platelet count before starting therapy and not >2 days before procedure.

Implementation

• Begin dosing 8–14 days before scheduled procedure. Procedure should occur 2–8 days after last dose.
• PO Take once daily without regard to food for 7 days.

Patient/Family Teaching

• Instruct patient to take medication as directed. Take missed doses as soon as remembered on same day and return to scheduled dose next day. Advise patient to read  Patient Information  before starting therapy.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
• Rep:  Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during and for at least 28 days after last dose.

Evaluation/Desired Outcomes

• Reduction in need for platelet transfusions prior to procedure.
• Reduction in need fore rescue therapy for bleeding after procedure.
• Increased platelet count.