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What Medication Is Used To Increase Platelets? A Comprehensive Guide to Treatment Options

4 min read

According to the National Heart, Lung, and Blood Institute (NHLBI), immune thrombocytopenia (ITP) is one of several conditions causing a low platelet count, requiring specific treatments. For patients facing such diagnoses, understanding what medication is used to increase platelets is an essential part of managing their health and preventing serious bleeding complications.

Quick Summary

A variety of medications, including thrombopoietin receptor agonists, corticosteroids, and immunoglobulins, are used to increase low platelet counts. These treatments are chosen based on the underlying cause of thrombocytopenia and specific patient needs. Newer agents are also available for chronic conditions.

Key Points

  • Thrombopoietin Receptor Agonists (TPO-RAs): This drug class directly stimulates the bone marrow to produce more platelets by mimicking the natural hormone thrombopoietin.

  • Oral TPO-RAs: Eltrombopag (Promacta) and avatrombopag (Doptelet) are oral medications used for ITP and other conditions, though eltrombopag has strict dietary restrictions.

  • Injectable TPO-RA: Romiplostim (Nplate) is a weekly subcutaneous injection for chronic ITP and offers an alternative for patients preferring or needing an injectable form.

  • Corticosteroids: Drugs such as prednisone can increase platelets by suppressing the immune system but are typically used for a limited time due to long-term side effects.

  • Immunoglobulin Therapy: Intravenous immunoglobulin (IVIG) and Anti-D immunoglobulin are used to rapidly increase platelet counts by temporarily blocking immune destruction.

  • Other Immunomodulatory Agents: Rituximab and Fostamatinib are other options for ITP that target immune system pathways responsible for platelet destruction.

In This Article

Understanding Thrombocytopenia and Treatment Goals

Thrombocytopenia is a medical condition characterized by an abnormally low number of platelets in the blood. Platelets, or thrombocytes, are small, colorless cell fragments that form clots to stop or prevent bleeding. A dangerously low platelet count increases the risk of excessive bruising and bleeding. The causes of thrombocytopenia are diverse, ranging from immune system disorders like immune thrombocytopenia (ITP) to viral infections, medication side effects, liver disease, or bone marrow suppression from chemotherapy.

The primary goal of treating thrombocytopenia is to raise the platelet count to a safe level to prevent or manage bleeding. The choice of medication depends heavily on the root cause of the condition, its severity, and whether it is acute or chronic.

Primary Medication Class: Thrombopoietin Receptor Agonists (TPO-RAs)

One of the most direct and effective strategies for increasing platelet production involves the use of thrombopoietin receptor agonists (TPO-RAs). These drugs mimic the natural hormone thrombopoietin, which signals the bone marrow to produce more platelets. TPO-RAs are a standard second-line therapy for chronic ITP in patients who have not responded adequately to initial treatments.

Eltrombopag (Promacta, Alvaiz)

This medication is an orally administered TPO-RA that stimulates the thrombopoietin receptor to increase platelet production. It is approved for several conditions, including chronic ITP, thrombocytopenia associated with chronic liver disease, and severe aplastic anemia. Eltrombopag is taken daily, but requires strict dietary adherence to be effective. It must be taken on an empty stomach and timed appropriately around calcium-rich foods and supplements containing polyvalent cations like iron, calcium, and magnesium, as these interfere with its absorption.

Romiplostim (Nplate)

As a peptibody, Romiplostim works in a similar way to eltrombopag by binding to and activating the TPO receptor. However, it is administered as a weekly subcutaneous injection, typically by a healthcare provider. This provides an alternative for patients who prefer injections or cannot adhere to the strict oral administration requirements of eltrombopag. It is commonly used for chronic ITP in both adults and children.

Avatrombopag (Doptelet) and Lusutrombopag (Mulpleta)

These are newer, oral TPO-RAs that are less affected by dietary cations, offering a more flexible administration schedule than eltrombopag. They are primarily indicated for patients with chronic liver disease who are preparing for a medical or dental procedure. Avatrombopag also has an indication for chronic ITP.

Other Medications to Increase Platelets

Depending on the specific cause of the low platelet count, several other classes of medication are also used:

  • Corticosteroids: Drugs like prednisone and dexamethasone are often used as a first-line treatment for ITP. They work by suppressing the immune system, thereby reducing the destruction of platelets. They are typically used for a limited duration due to potential side effects with long-term use.
  • Intravenous Immunoglobulin (IVIG): This therapy uses a concentrated solution of antibodies given intravenously to block the immune system's destruction of platelets. IVIG is effective at rapidly raising platelet counts and is often used for severe bleeding or before surgery.
  • Rituximab: A monoclonal antibody that targets B-cells, Rituximab is used to treat ITP in patients who have not responded to corticosteroids. It works by reducing the immune response that produces anti-platelet antibodies.
  • Fostamatinib (Tavalisse): This is a spleen tyrosine kinase (SYK) inhibitor approved for adults with chronic ITP who have failed previous treatments. It prevents the destruction of platelets mediated by the immune system.
  • Anti-D Immunoglobulin: Used for Rh-positive individuals with immune thrombocytopenia, this medication blocks the removal of antibody-coated platelets from circulation.

Comparing Key Thrombopoietin Receptor Agonists

Feature Eltrombopag (Promacta) Romiplostim (Nplate) Avatrombopag (Doptelet)
Route of Administration Oral tablet or suspension Weekly subcutaneous injection Oral tablet
Dietary Restrictions Avoid polyvalent cations (calcium, iron) 2-4 hours before/after dosing. None. None.
Mechanism of Action Small molecule that binds non-competitively to the TPO receptor transmembrane domain. Peptibody that binds competitively to the TPO receptor extracellular domain. Small molecule that binds non-competitively to the TPO receptor.
Side Effects Increased liver enzymes, cataracts, risk of thrombosis, fatigue, headache. Joint/muscle pain, headache, dizziness, increased bone marrow reticulin, risk of thrombosis. Headache, fatigue, contusion, epistaxis, risk of thrombosis.
Monitoring Regular liver function tests, ocular exams recommended. Platelet counts are closely monitored; regular check-ups. Platelet counts are closely monitored.

Supporting Interventions and Conclusion

In emergency situations involving severe bleeding, a platelet transfusion may be administered to temporarily increase the platelet count. This is not a long-term solution but a critical intervention for acute crises. For severe, refractory ITP, a splenectomy (surgical removal of the spleen) may be considered if other treatments fail.

In conclusion, the decision regarding what medication is used to increase platelets is complex and depends on the specific cause and patient profile. Thrombopoietin receptor agonists (TPO-RAs) like eltrombopag and romiplostim are highly effective options for chronic ITP and other related conditions by directly boosting platelet production. Alongside these, corticosteroids, IVIG, and other immunomodulatory agents play vital roles in managing low platelet counts caused by immune system activity. Consulting a hematologist is critical for determining the most appropriate and safest treatment plan.

For more detailed information on specific conditions like ITP, consult authoritative medical sources like the National Heart, Lung, and Blood Institute.

Frequently Asked Questions

Intravenous Immunoglobulin (IVIG) is often used for rapid platelet increase in emergency situations, such as active bleeding. Corticosteroids can also raise platelet counts relatively quickly.

No, eltrombopag should not be taken with a meal rich in calcium or other polyvalent cations. It should be taken at least two hours before or four hours after consuming such foods, supplements, or antacids to ensure proper absorption.

Administration frequency depends on the specific TPO-RA. Oral medications like eltrombopag are taken daily, while romiplostim is a weekly injection administered by a healthcare professional.

In some cases, especially severe or refractory ITP, a splenectomy (surgical removal of the spleen) is a potential treatment option when medications are ineffective. Platelet transfusions are used for emergencies.

The main differences are administration route (oral vs. injection), binding site on the TPO receptor, and dietary restrictions. Eltrombopag is an oral tablet with dietary constraints, while romiplostim is a weekly subcutaneous injection with no food restrictions.

Clinical data suggests TPO-RAs are generally well-tolerated for long-term use, though long-term monitoring for potential adverse events like thrombosis and bone marrow fibrosis is advised.

Yes, certain medications like some antibiotics (e.g., sulfonamides), diuretics, and chemotherapy drugs can induce thrombocytopenia as a side effect.

References

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Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice.