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Avatrombopag oral

Updated 2 Feb 2023 | Platelet disorders


Oral formulation of avatrombopag.

Drugs List

  • avatrombopag 20mg tablets
  • DOPTELET 20mg film coated tablets
  • Therapeutic Indications


    Severe thrombocytopenia with chronic liver disease
    Thrombocytopenia - immunogenic

    Treatment of severe thrombocytopenia in adults with chronic liver disease who are scheduled to undergo an invasive procedure.

    Treatment of primary chronic immune thrombocytopenia (ITP) in adults who are refractory to other treatments.


    The recommended daily dose of avatrombopag is based on the patient's platelet count.


    Severe Thrombocytopenia with Chronic Liver Disease
    Avatrombopag should not be taken for more than 5 days. Dosing should begin 10 to 13 days prior to the scheduled invasive procedure. The patient should undergo the procedure 5 to 8 days after the last dose of avatrombopag.

    Platelet count of less than 40 x 10 to the power 9 per litre
    60mg once daily for 5 days

    Platelet count of greater than or equal to 40 x 10 to the power 9 per litre but less than 50 x 10 to the power 9 per litre
    40mg once daily for 5 days

    Primary Chronic Immune Thrombocytopenia (ITP)
    Use the lowest dose to achieve and maintain a platelet count greater than or equal to 50 x 10 to the power 9 per litre.

    Initial dose
    20mg once daily with food

    Avatrombopag dose levels for titration in patients with ITP
    Dose Level 6: 40mg once daily
    Dose Level 5: 40mg three times a week and 20mg on the four remaining days for each week
    Dose Level 4: 20mg once daily
    Dose Level 3: 20mg three times a week (three non-consecutive days a week e.g. Monday, Wednesday and Friday)
    Dose Level 2: 20mg twice a week or 40mg once weekly (two non-consecutive days a week e.g. Monday and Friday)
    Dose Level 1: 20mg once weekly (the same day each week)

    Platelet count of less than 50 x 10 to the power 9 per litre after at least 2 weeks of avatrombopag treatment
    Increase One Dose Level, wait 2 weeks to assess the effects of this regimen and any subsequent dose adjustments.

    Platelet count of greater than 150 x 10 to the power 9 per litre and less than or equal to 250 x 10 to the power 9 per litre
    Decrease One Dose Level,wait 2 weeks to assess the effects of this regimen and any subsequent dose adjustments.

    Platelet count of greater than 250 x 10 to the power 9 per litre
    Stop avatrombopag treatment. Increase platelet monitoring to twice weekly. When platelet count is less than 100x 10 to the power 9 per litre, decrease One Dose Level and reinitiate therapy.

    Platelet count of less than 50 x 10 to the power 9 per litre after 4 weeks of avatrombopag 40mg once daily
    Discontinue avatrombopag treatment.

    Platelet count of greater than 250 x 10 to the power 9 per litre after 2 weeks of avatrombopag 20mg weekly
    Discontinue avatrombopag treatment.

    Additional Dosage Information

    Missed doses
    If a dose is missed, take as soon as it is remembered. Two doses should not be taken at one time to make up for the missed dose. The next dose should be taken at the usual time the following day.

    Avatrombopag recommended starting doses for patients with ITP based on concomitant medications
    Moderate or strong dual inhibitors of CYP2C9 and CYP3A4/5, or of CYP2C9 alone
    20mg three times a week

    Moderate or strong dual inducers of CYP2C9 and CYP3A4/5, or of CYP2C9 alone
    40mg once daily


    Children under 18 years

    Precautions and Warnings

    Females of childbearing potential
    Major surgery
    Multiple risk factors for thromboembolic disease
    CYP2C9 poor metaboliser genotype
    Glucose-galactose malabsorption syndrome
    Lactose intolerance
    Severe hepatic impairment

    Perform platelet count prior to treatment and on the day of procedure
    Treatment to be initiated and supervised by a specialist
    Contains lactose
    Blood counts should be performed before and periodically during treatment
    Monitor platelet count weekly
    Perform peripheral blood smear prior to and during treatment
    Monitor for bleeding during treatment
    Monitor for signs and symptoms of hepatic encephalopathy
    Monitor liver function in patients with hepatic impairment
    Monitor platelet counts for 4 weeks following discontinuation
    Interrupt treatment if platelet count above 250x10 to the power of 9/L
    Discontinue if new or worsening morphological cell abnormalities develop

    There is an increased risk for thromboembolic events in patients with chronic liver disease or ITP. Patients with chronic liver disease who had platelet counts greater than 200 x 10 to the power 9 per litre, when receiving a thrombopoietin receptor agonist, have reported an increased frequency of portal vein thrombosis.

    Potential increased thrombotic risk when administering avatrombopag to patients with known risk factors for thromboembolism, including genetic prothrombotic conditions should be considered. Avatrombopag should not be administered to patients with chronic liver disease in an attempt to normalize platelet counts.

    Consider the potential for reduced platelet counts if co-administering avatrombopag with interferon preparations.

    The diagnosis of ITP should have been confirmed by the exclusion of other clinical entities presenting with thrombocytopenia, in particular the diagnosis of myelodysplastic syndrome (MDS) must be excluded. Consider performing a bone marrow aspirate and biopsy over the course of treatment, particularly in patients over 60 years of age, those with systemic symptoms or abnormal signs such as increased peripheral blast cells.

    Pregnancy and Lactation


    Avatrombopag is contraindicated during pregnancy.

    Use of avatrombopag during pregnancy and in women of childbearing potential not using contraception is contraindicated by the manufacturer. At the time of writing there is limited published literature regarding the use of avatrombopag during pregnancy. Potential risks are unknown.


    Avatrombopag is contraindicated during breastfeeding.

    The manufacturer advises that the patient either discontinues avatrombopag or discontinues breastfeeding. Animal data reports that avatrombopag is present in the breast milk, however presence in human breast milk and the effects on exposed infants are unknown.

    Side Effects

    Abdominal distension
    Abdominal pain
    Alanine aminotransferase increased
    Aspartate aminotransferase increased
    Back pain
    Blood glucose disturbances
    Bone pain
    Cerebrovascular accident
    Changes in mood
    Chest discomfort
    Cognitive impairment
    Decreased appetite
    Deep vein thrombosis (DVT)
    Discomfort in limb
    Dry skin
    Ear pain
    Eye irritation
    Eyelid pruritus
    Eyelid swelling
    Gastroesophageal reflux
    Hypersensitivity reactions
    Impaired vision
    Increase in lactate dehydrogenase
    Increase in plasma triglyceride concentration
    Increased appetite
    Increased blood pressure
    Increased lacrimation
    Increased platelet count
    Iron deficiency
    Muscle spasm
    Muscle weakness
    Musculoskeletal pain
    Myocardial infarction
    Nasal congestion
    Nipple discomfort
    Ocular discomfort
    Oral paraesthesia
    Painful extremities
    Portal vein thrombosis
    Pulmonary embolism
    Reduced platelet count
    Retinal artery occlusion
    Sensation of foreign body in eye
    Sensory disturbances
    Skin irritation
    Skin pigmentation changes
    Skin/soft tissue haemorrhage
    Tongue disorder
    Tongue swelling
    Transient ischaemic attack
    Upper abdominal pain
    Upper respiratory tract infection


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: March 2021

    Reference Sources

    Summary of Product Characteristics: Doptelet 20mg film coated tablets. Swedish Orphan Biovitrum Ltd. Revised October 2021.

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