ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Thrombopoietin Receptor Agonist (Peptibody) Pregnancy: C

Romiplostim

Brand names: Nplate

Adult dose

Dose: 1 microgram/kg SC once weekly; titrate by 1 microgram/kg weekly to platelet count 50–200 × 10⁹/L
Route: subcutaneous injection
Frequency: once weekly
Max: 10 micrograms/kg/week
Dose rounded to nearest whole microgram/kg; discontinue if no response at 16 weeks of maximum dose; REMS programme required

Paediatric dose

Dose: 1 micrograms/kg
Route: subcutaneous
Frequency: once weekly
Max: 10 micrograms/kg/week
Concentration: 125 micrograms/vial or 500 micrograms/vial (reconstitute) micrograms/ml
Licensed ≥1 year for persistent/chronic ITP; same weight-based dosing as adults

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Licensed ≥1 year for persistent/chronic ITP; same weight-based dosing as adults

Clinical pearls

  • Peptibody structure (not an antibody to TPO receptor — no neutralising antibodies)
  • Bone marrow biopsy if peripheral blood smear shows abnormal cells (leukoerythroblastic picture)
  • Rebound thrombocytopaenia on discontinuation — taper dose, monitor closely

Contraindications

  • Myelodysplastic syndromes (risk of conversion to AML)

Side effects

  • Headache
  • Fatigue
  • Arthralgia
  • Bone marrow fibrosis (reticulin/collagen)
  • Thromboembolism
  • Thrombocythaemia rebound (on withdrawal)

Interactions

  • Anticoagulants (platelet count changes affect dosing)
  • Antiplatelets

Monitoring

  • Platelet count weekly until stable
  • Peripheral blood smear monthly
  • Bone marrow biopsy if indicated

Reference: BNFc; BNF 86; NICE TA221; EXTEND trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways