Thyroid-blocking medications should be given before the injection is usually administered. Drugs that interfere with NE uptake or retention may decrease the drugs uptake in neuroendocrine tumors and may Betulin lead to false-negative imaging results. bone marrow reticulin deposition had received doses of 5 Betulin mcg/kg or more, and six received doses of 10 mcg/kg or more. In the controlled clinical studies, progression to marrow fibrosis with cytopenia was not reported. In the extension study, marrow fibrosis with collagen developed in one patient with ITP and hemolytic anemia during romiplostim therapy. Clinical studies have not excluded a risk of bone marrow fibrosis with cytopenia. Before romiplostim therapy begins, the peripheral blood smear should be examined to establish a baseline level of cellular morphological abnormalities. After a stable romiplostim dose is usually identified, peripheral blood smears and a complete blood count (CBC) should be assessed monthly to look for cytopenia or new or worsening morphological abnormalities, such as teardrop and nucleated red blood cells or immature white blood cells. If such abnormalities or cytopenias develop, romiplostim should be discontinued and a bone marrow biopsy, including staining for fibrosis, should be considered. Discontinuation of romiplostim may result in thrombocytopenia more severe than that which was present before therapy. The worsened thrombocytopenia may increase the risk of bleeding, particularly if Betulin the agent is usually discontinued while the patient had been taking anticoagulant or antiplatelet brokers. In studies of patients with chronic ITP who discontinued romiplostim, four of 57 patients developed thrombocytopenia of a greater severity than before therapy. This worsened thrombocytopenia resolved within 14 days. After romiplostim is usually discontinued, weekly CBCs, including platelet counts, should be obtained for at least two weeks, and option therapy for worsening thrombocytopenia should be considered, according to treatment guidelines. Complications may result from an increased platelet count. Excessive doses of romiplostim, or medication errors that result in excessive romiplostim doses, may increase platelet counts to a level that produces thrombotic or thromboembolic sequelae. In controlled trials, the incidence of these complications was comparable for both romiplostim and placebo. To minimize the risk of these complications, clinicians should not use romiplostim in an attempt to normalize the platelet count number. Dose-adjustment guidelines should be followed to achieve and maintain a platelet count of 50 109/L or higher. A poor response or a failure to maintain a platelet response with romiplostim should prompt a search for a cause, including neutralizing antibodies to romiplostim or bone marrow fibrosis. To detect antibody Rabbit Polyclonal to B-Raf (phospho-Thr753) formation, clinicians should submit blood samples to Amgen to assay these samples for antibodies to romiplostim and TPO. Romiplostim should be discontinued if the platelet count does not increase to a Betulin level sufficient to avoid Betulin clinically important bleeding after four weeks at the highest weekly dose of 10 mcg/kg. Stimulation of the TPO receptor on the surface of hematopoietic cells may increase the risk of hematological malignancies. In controlled studies of chronic ITP, the incidence of hematological malignancy was low and was comparable for romiplostim and placebo. In a separate single-arm clinical study of 44 patients with myelodysplastic syndrome (MDS), 11 patients experienced possible disease progression; four of these patients had acute myelogenous leukemia during follow-up. Romiplostim is not indicated for treating thrombocytopenia attributable to MDS or to any cause of thrombocytopenia other than chronic ITP. The CBC, including platelet counts and peripheral blood smears, should be monitored before, during, and after discontinuation of romiplostim therapy. Before romiplostim is initiated, the peripheral blood differential should be examined to establish the baseline extent of red blood cell (RBC) and white blood cell (WBC) abnormalities. A CBC, including platelet counts and peripheral blood smears, should be obtained weekly during the dose-adjustment phase of therapy, then monthly after a stable romiplostim dose is established. A CBC with platelet counts should be obtained each week for at least two weeks after discontinuation of romiplostim. Romiplostim is usually available only through the romiplostim NEXUS Program (Network of Experts Understanding and Supporting Romiplostim and Patients). Only registered health care providers.
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