How it is administered

Romiplostim is administered as a subcutaneous injection (an injection under the skin). It is supplied as a sterile, preservative-free, lyophilized powder that must be reconstituted with Sterile Water for Injection before use. The medication comes in single-dose vials containing 125 mcg, 250 mcg, or 500 mcg of romiplostim. The dose is calculated based on your body weight and is given once weekly. Only a healthcare provider should prepare and administer this medication.

How it works

Romiplostim is a thrombopoietin receptor agonist (TPO-RA). It works by mimicking the action of thrombopoietin, a natural hormone in your body that stimulates the production of platelets from bone marrow cells. By binding to and activating the thrombopoietin receptor, romiplostim encourages your bone marrow to produce more platelets, which are essential for blood clotting and reducing the risk of bleeding.

This medication is especially useful in conditions where the body’s platelet count is low, such as immune thrombocytopenia (ITP). It does not have the same amino acid sequence as the natural hormone, but it acts in a similar way to increase platelet production. The effects on platelet counts are dose-dependent, and the medication is adjusted to maintain a safe platelet level.

Who Should take it

Romiplostim is indicated for adult and pediatric patients (1 year and older) with immune thrombocytopenia (ITP) who have had an insufficient response to other treatments like corticosteroids, immunoglobulins, or splenectomy. It is also used to increase survival in patients acutely exposed to myelosuppressive doses of radiation (Hematopoietic Syndrome of Acute Radiation Syndrome).

However, it is important to note that romiplostim is NOT indicated for the treatment of thrombocytopenia due to myelodysplastic syndrome (MDS) or any cause of thrombocytopenia other than ITP. It should only be used in patients whose degree of thrombocytopenia and clinical condition increases the risk for bleeding.

Who should not take it

There are no absolute contraindications listed for romiplostim. However, it should NOT be used for the treatment of thrombocytopenia due to myelodysplastic syndrome (MDS) or any cause of thrombocytopenia other than ITP.

Caution is advised in patients with a history of thrombotic or thromboembolic events, as the medication can increase the risk of blood clots. Patients with chronic liver disease should also be monitored closely, as portal vein thrombosis has been reported. Pregnant or breastfeeding women should discuss potential risks with their healthcare provider, as animal studies suggest possible harm to the fetus.

Commonly used with

Romiplostim may be used with other medical therapies for ITP, such as corticosteroids, danazol, azathioprine, intravenous immunoglobulin (IVIG), and anti-D immunoglobulin. These medications may be continued at a constant dosing schedule while receiving romiplostim, and rescue therapies may be used if needed for bleeding or risk of hemorrhage.

Commonly tested with

In clinical studies, romiplostim has been tested alongside other ITP treatments, including corticosteroids, immunoglobulins, rituximab, cytotoxic therapies, danazol, and azathioprine. Rescue therapies such as corticosteroids, IVIG, platelet transfusions, and anti-D immunoglobulin were also permitted during studies for patients at immediate risk for bleeding.