Avatrombopag tablets for oral use were approved by the FDA in May 2018 for treating thrombocytopenia in adults with severe liver disease and scheduled to undergo a medical or surgical procedure.
Avatrombopag tablets are prescribed for treating abnormally low platelet counts or a condition of thrombocytopenia in adult patients with severe liver dysfunction who are planning to undergo a medical or dental procedure.
Thrombocytopenia is found to be a common complication in patients with severe liver disease either due to liver pathologies or as a result of interferon-based antiviral treatment.
Avatrombopag is a small molecule thrombopoietin (TPO) receptor agonist that works by rapidly increasing the number of platelets from the megakaryocytes in the bone marrow and thereby reducing the need for blood transfusions.
However, it does not result in increased platelet activation which could lead to blood clotting and several complications.
Avatrombopag should not be used with a focus to normalize platelet counts and in patients with-
Allergy to avatrombopag
Pregnancy and breastfeeding
Children below 18 years of age
History of clotting disorders (e.g., Thrombophilia)
Severely dehydrated patients (e.g., Hyponatremia or abnormally low sodium level)
Caution is required in treating the following patients as safety and effectiveness parameters have not been studied in these groups
Severe kidney disease or in patients undergoing hemodialysis
The recommended adult dose of avatrombopag depends on the individual patients platelet count performed before a procedure is planned.
Platelet count (Χ109/L) and the recommended dose:
Count 50 to 40 Χ 109/L: Take 40 mg (2 tablets) of avatrombopag once a day for five consecutive days
Count below 40 Χ 109/L: Take 60 mg (3 tablets) of avatrombopag once daily for five consecutive days
Avatrombopag tablets are available at a strength of 20 mg and should be taken by mouth once a day with food to avoid gastric discomfort.
Do not take for more than 5 days unless otherwise recommended by the physician.
Platelet count should be performed before starting avatrombopag treatment and also repeated on the day of the procedure to assess the improvement in platelet count.
To protect the child from exposure to avatrombopag, breastfeeding mothers should not be allowed to breastfeed their child during the treatment and for at least two weeks after the last dose of avatrombopag.
Patients should be closely monitored for any clotting risk or thromboembolic complications to prevent serious life-threatening or fatal conditions.
Complete blood cell count and electrolyte evaluation should be performed regularly to detect the risk of low sodium level and other related blood disorders and treated accordingly.
The most common side effects experienced by the patients taking avatrombopag are-
Low sodium levels
Fatigue or weakness
Swelling of the extremities such as legs or hands
Other side effects include-
Risk of developing blood clots
Muscle pain or tenderness
Difficulty in breathing
Pain in the chest
Abnormalities in heart rhythm
If a dose is missed, it should be taken immediately as soon as you remember.
Never take a double dose to make up for the missed dose.
The dose of avatrombopag should not be stopped without the consent of the physician.
Patients should not take anticoagulants such as warfarin or heparin as it may increase side effects of avatrombopag such as risk of blood clotting and other thrombotic or thromboembolic complications.
Diuretic drugs or water pills such as furosemide, hydrochlorothiazide or indapamide should not be taken with avatrombopag as it may cause severe electrolyte depletion such as sodium loss resulting in serious illnesses.
Before starting avatrombopag therapy, the prescriber should be informed about intake of all prescription or non-prescription drugs or herbal supplements by the patients.
Store avatrombopag tablets at room temperature between 20°C and 25°C.
Keep the tablets in its original package and protect from excess heat and moisture.
Keep out of reach of children.
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