NPLATE Question

My dad has been taking NPLATE for a number of years. His previous doctors always aimed for a platlet count of 50,000 and if the count was above that, he was not required to get a shot. His current doctor is telling him that he has to have the shot weekly if his counts are not 250,000 per FDA guidelines. NPLATE denies this is an FDA requirement. I would appreciate any input on how others are reciving NPLATE and whether weekly shots are being required.

Thanks to all in advance!

Lori

My husband took Nplate for at least three years, but the side effects of headaches and dizziness were increasing so he asked to stop it. Nplate is not intended to get the platelets up to "normal", but to maintain a safe level of a range from 30,000 on up. My husband seldom got over 100.000. He did have the shot every week, even if the count was over 50,000, and maintained the range well until he had a sudden drop a few months ago. I think the MD's statement of having to have the platelets at 250,000 is way out of line and I believe Amgen, the maker of Nplate, does not say that.

I've used it for nearly three years and I aim for a count of 30 to 50. I agree that 250 is far too high for this drug. I worry more about clotting than I do bleeding so I'd rather be lower than high.

Thanks for the feedback. Has anyone taking NPLATE been given the option of not taking the shot weekly if the counts are holding above 50,000?

So what would happen if he'd just say no?

I wouldn't get the shot with higher counts either.

Yes, Bub, people do go to fortnightly (two weekly) injections, someone here on the forum does one every three weeks. I have also missed weeks out when my count is high enough as I am on the lowest dose and can't therefore simply lower the dose as I would if my count were over 100. I self inject so it's easier for me.

I do not think that is an FDA requirement. This is what the PDF from Amgen's website says:
[url] www.amgen.com/medpro/products_nplate.html [/url]

(Recommended Dosage Regimen)
Use the lowest dose of Nplate to achieve and maintain a platelet count ≥ 50 x 109/L as necessary to reduce the risk
for bleeding.

and..............................

(Adjust the dose as follows)
• If the platelet count is < 50 x 109/L, increase the dose by 1 mcg/kg.
• If platelet count is > 200 x 109/L for 2 consecutive weeks, reduce the dose by 1 mcg/kg.
• If platelet count is > 400 x 109/L, do not dose. Continue to assess the platelet count weekly. After the platelet count has fallen to < 200 x 109/L, resume Nplate at a dose reduced by 1 mcg/kg.

The guidelines are different in the UK ..

If the count is > 150 for 2 weeks, reduce the dose
If the count is > 250 do not dose.

I never waited for two weeks and always lowered the dose after one high week. The OP's doctor is simply saying what he wants to do but afraid that that won't be enough to convince the OP so is trying to put some other force behind it by saying it comes from the FDA. In fact Amgen will say that the doctor can make their own rules to suit the patient's particular situation.

my dr. says 50K

Yes, 50 is the aim but they do often go higher on Nplate. It's difficult to get a stable count.