What medications can raise platelet count? An Overview of Therapeutic Options

October 12, 2025 •

4 min read

While the exact cause of low platelet count (thrombocytopenia) can vary, therapeutic interventions are often necessary, and an increasing number of medications can raise platelet count by addressing either the underlying production issue or the increased destruction of platelets.

Quick Summary

Different classes of medications, including thrombopoietin receptor agonists (TPO-RAs), corticosteroids, and immunoglobulins, can effectively increase platelet levels for conditions like immune thrombocytopenia (ITP) and chronic liver disease.

Key Points

Thrombopoietin Receptor Agonists (TPO-RAs): This class of medication, including romiplostim (Nplate) and eltrombopag (Promacta), works by stimulating bone marrow to increase platelet production.
Corticosteroids: Drugs like prednisone and dexamethasone suppress the immune system to prevent platelet destruction and are often used as initial, short-term treatment for ITP.
Immunoglobulins: Given intravenously, IVIG and Anti-D immunoglobulin provide a temporary boost to platelet counts by blocking immune destruction, making them useful for emergencies.
Other Immunosuppressants: In cases resistant to other treatments, drugs like rituximab and danazol can suppress the immune response that targets platelets.
Professional Supervision is Crucial: All medications to raise platelet count require close monitoring by a healthcare provider due to potential side effects, including blood clots and liver issues.
Tailored Treatment: The optimal medication or combination of therapies depends on the specific cause of thrombocytopenia and the patient's individual health profile.

A healthy platelet count is crucial for proper blood clotting and preventing excessive bleeding. When a person's platelet count drops too low, a condition known as thrombocytopenia, a healthcare provider may prescribe medications to address the issue. The treatment approach depends heavily on the underlying cause, which could be an autoimmune disorder like immune thrombocytopenia (ITP), a side effect of another illness or medication, or a problem with bone marrow production.

Thrombopoietin Receptor Agonists (TPO-RAs)

Thrombopoietin (TPO) is a hormone that naturally stimulates the bone marrow to produce platelets. TPO-RAs are a newer class of medications that mimic this hormone, directly binding to and activating the TPO receptor on precursor cells to increase platelet production. They are typically used for chronic ITP when other treatments have failed and are also approved for patients with chronic liver disease who require a procedure and for severe aplastic anemia.

Common TPO-RAs include:

Romiplostim (Nplate): An injectable 'peptibody' administered subcutaneously, usually once per week. It binds to the TPO receptor in the same location as endogenous TPO.
Eltrombopag (Promacta, Alvaiz): An oral tablet or suspension taken daily. Its absorption is significantly reduced by multivalent cations like calcium and iron, so it must be taken at least two hours before or four hours after meals, supplements, or antacids containing these minerals.
Avatrombopag (Doptelet): An oral tablet approved for use in adults with ITP and those with chronic liver disease requiring a procedure. Unlike eltrombopag, it can be taken with food.
Lusutrombopag (Mulpleta): An oral tablet specifically for patients with chronic liver disease needing a procedure.

Corticosteroids

As a frontline treatment for ITP, corticosteroids such as prednisone and dexamethasone suppress the immune system, which helps prevent the destruction of platelets. While highly effective at raising platelet counts relatively quickly, they are typically prescribed for a short duration due to the risk of significant side effects with long-term use. Side effects can include high blood sugar, high blood pressure, mood changes, insomnia, digestive problems, and an increased risk of infection.

Immunoglobulins

Immunoglobulins, or concentrated antibodies collected from donors, can be used to treat ITP and other causes of thrombocytopenia, especially in emergency situations or before surgery.

Intravenous Immunoglobulin (IVIG): Administered as an infusion, IVIG is thought to work by blocking the immune system's destruction of platelets. Its effect is generally temporary, lasting for a few weeks.
Anti-D Immunoglobulin: Used specifically for some people with Rh-positive blood who have immune thrombocytopenia. The exact mechanism is not fully understood, but it is believed to stop the spleen from destroying platelets.

Other Immunosuppressants

For patients with ITP who do not respond to corticosteroids or other initial therapies, more potent immunosuppressants may be necessary to control the immune system's attack on platelets. Examples include azathioprine, cyclophosphamide, and cyclosporine. Rituximab, a type of antibody treatment, can also be used to suppress the immune system response that destroys platelets. Danazol, an attenuated androgen, is another option that may provide long-term remission in some cases of chronic ITP. These medications carry a higher risk of side effects, particularly increasing the patient's susceptibility to infections.

Comparison of Key Medications that Can Raise Platelet Count


Feature	TPO-RAs	Corticosteroids	Immunoglobulins	Danazol
Mechanism	Stimulates bone marrow to produce more platelets.	Suppresses immune system and inflammation.	Blocks immune system from destroying platelets.	Reduces immune-mediated destruction of platelets.
Route	Oral (Eltrombopag, Avatrombopag) or Subcutaneous Injection (Romiplostim).	Oral (Prednisone, Dexamethasone).	Intravenous (IVIG, Anti-D Immunoglobulin).	Oral.
Use Case	Chronic ITP, liver disease, aplastic anemia (often second-line).	Initial treatment for ITP, typically short-term.	Emergency treatment, rapid boost before surgery.	Chronic ITP (second-line), particularly for long-term management.
Speed of Effect	Can take 1-2 weeks or longer.	Can show effect within 5-10 days.	Within days, but effect is temporary.	Can take months for full effect.
Primary Side Effects	Blood clots, liver issues, cataracts.	High blood sugar, high blood pressure, osteoporosis, mood changes.	Headaches, chills, fever, nausea (infusion reaction).	Liver damage, hyperglycemia, virilization (in women).
Dietary Restrictions	Eltrombopag requires spacing from polyvalent cations (calcium, iron).	No specific dietary restrictions listed.	None specified.	None specified.

Considerations for Prescribing and Monitoring

Choosing the right medication to increase platelet count is a complex decision made by a hematologist or other healthcare provider. It involves weighing the patient's specific condition, potential risks, side effects, and treatment goals. Regular blood monitoring is essential to track platelet levels and adjust dosages. For example, platelet levels should be checked regularly during TPO-RA therapy to prevent overshooting the target range, which could increase the risk of blood clots. Patients should also be aware of specific monitoring needs, such as liver function tests for those on eltrombopag.

Conclusion

Therapy for low platelet count has evolved, with newer options like TPO-RAs offering targeted approaches to increase platelet production, while older, well-established treatments like corticosteroids and immunoglobulins remain vital in certain clinical situations. For many patients with chronic or relapsed ITP, TPO-RAs like romiplostim and eltrombopag have proven to be effective and durable treatment options. It is critical to work closely with a healthcare team to determine the most appropriate course of action, which may involve a combination of therapies, regular monitoring, and lifestyle adjustments to manage the condition safely and effectively.

For more detailed information on specific conditions like immune thrombocytopenia, consult the National Heart, Lung, and Blood Institute: Immune Thrombocytopenia (ITP) - NHLBI.

Frequently Asked Questions

Intravenous Immunoglobulin (IVIG) and corticosteroids are often used to quickly raise platelet counts in emergencies or when rapid increases are needed, such as before surgery. IVIG's effects are typically fast but temporary, lasting a few weeks.

While a balanced diet is important for overall health, there is no reliable evidence that specific foods or supplements can effectively treat clinical thrombocytopenia. Eltrombopag absorption is, however, affected by calcium and iron, so food timing is relevant for that medication.

The duration of treatment varies. Corticosteroids are often short-term, while TPO-RAs may be used long-term for chronic conditions like ITP. The timeline depends on the specific medication and your response to treatment.

Potential risks vary by medication. TPO-RAs can increase the risk of blood clots and liver issues, while corticosteroids have a range of side effects including elevated blood sugar and bone density loss with prolonged use. A healthcare provider will monitor these risks closely.

Yes, it is possible for platelet counts to become too high while on medication, which can increase the risk of blood clots. Healthcare providers monitor platelet levels with regular blood tests and adjust the medication dose as needed to prevent this.

No. TPO-RAs are primarily indicated for specific conditions such as chronic ITP, thrombocytopenia associated with chronic liver disease, and severe aplastic anemia. They should not be used in patients with myelodysplastic syndromes (MDS).

Discontinuing medication, especially TPO-RAs, can cause a patient's platelet count to drop below the level it was at before treatment, increasing the risk of bleeding. This is why close medical supervision is necessary when stopping treatment.