Micro-adjusting Promacta Dosages

I've been on Promacta for a year now, and my counts have ranged from a low of 12K (at 50mg) to 144K (on 75 mg). Slammed and I have been having an email discussion of how we adjust our dosages to try to get the "target" count (50K according to Glaxo) with the minimum dosage. We seemed to have gotten different medical and pharmacological advice, with my pro's in the Southeast saying it is fine to cut the pills, and Slammed's pro's in the Southwest saying it is not.

We are wondering if any other persons using Promacta have adjusted their dosages using fractions of pills??!! I have been cutting my pills now for about six months, and you can definitely see the increases that a quarter or half pill makes on my counts, so I believe it is definitely working, a procedure which is OK'd by my hematologist. I think Slammed is afraid of trying this. Any other experiences out there?!

I haven't asked my hema about this yet. I just asked the oncology pharmacists. I will ask him when I see him in about 2 weeks. I explained in my post earlier why the pharmacists recommended why I do not cut up Promacta.

Here's my experience regarding the two concerns expressed by your pharmacists:

1) "No line on the pill to accurately cut it, so the dosage may not be exact"--I cut 25 mg. tablets in halves and in quarters. True, each pill does not cut exactly the same, but my counts do increase when I take even a quarter pill (roughly 6.25 mgs)in addition to my usual dosage. I really don't care whether I am getting 56.25mg. or 56 mgs; the point is getting the closest count to the recommended 50,000K platelet count with the least amount of medicine;

2) "The coating may help to absorb the drug"--I've seen no evidence that my quarter pill (which has no coating on the two cut sides, but still has coating on the other 3 sides)is ineffective. In fact, I take only a quarter pill to avoid going too far over the 50K goal. This method of titrating the dosage seems the only practical way to get intermediate dosages, as Promacta only comes in 25,50 and 75 mg. pills, but I'm open to suggestions!!

Call the Manufacturer and tell them to make lower dosage pills! :evil:

Promacta do come in 12.5mg and 100mg too...I have taken 12.5mg for about 6-7 months last year.

www.gsksource.com/gskprm/htdocs/documents/PROMACTA.PDF

It's been a while since I posted, but I did want to bring you (Slammed) up to date on this discussion we had and post this "for the record." Bottom line is I gave up on trying to titrate the Promacta by cutting pills because it just didn't make any difference. My numbers fluctuate between 18K and 66K and I have found no relationship whatsoever between the mini-dosage changes (e.g. using one and a quarter pills for dosage vs. taking one pill).

As many people have noted before me on this site, each of us seems to come up with a program to manage ITP that is somewhat unique. I have found that Promacta works for me, but i know others have had trouble with it. I have also learned that the "numbers" really don't matter, and finally got my doc to reduce my monitoring from weekly to monthly, although I will next request bi-monthly (unless I have some classic ITP symptoms). I'm still not crazy about taking this medication--given the black box warnings and concerns expressed by others--so I will next try to reduce the dosage down from 50 to 25mg, just to "test the waters," especially given the discussions here that some people would rather risk low numbers than the potential side effects of the meds. Thanks again for all of your input and help!

I am curious whether micro-adjusting by cutting pills is any different in effect than using alternating days to achieve the same average effect. For example, would taking 25 mg on MWF and 12.5 mg on TThSaSu be the same as taking 125 mg per week /7 = 17.9 mg/day. This would allow for easier fine tuning, and would be easier than splitting pills, especially if you use a pill-minder to lay out your pills for the week. The half-life in ITP patients is 26 - 35 hours, which is fairly long and should accommodate this. Any thoughts?

Also, I wonder if some of the variation in counts might, for some people, be due to variations of when they take the medications in relation to meals, supplements, and other medication. When one takes a dose can reduce its effectiveness by as much as 75%!

... administration of a... 25-mg dose... with a... moderate-calorie meal reduced plasma eltrombopag ... by 75% ...
Administration of a ... 25-mg dose ... 2 hours after the ... meal reduced plasma eltrombopag ... by 47% ...
Administration of a ... 25-mg dose ... 2 hours before the ... meal reduced plasma eltrombopag... by 20%...

www.rxlist.com/promacta-drug/clinical-pharmacology.htm

Good questions...I agree with you that alternating days vs. cutting the pills may be equivalent numerically in terms of dosage, but my experience has been that it takes 1-2 weeks from the initiation of the drug to reach the maximum clinical effect. So having days with no new med at all (i.e. the alternate pill method) seems to me risks letting the level of Promacta in your system drop below clinically effective levels. In other words, while you may be dealing with the same relative dosage over a week's time, you may have times where the drug is present in sub-clinical amounts, and thus essentially ineffective during those days. I guess it would take some research to answer this question definitively!

I think Emily has done alternate day dosing and I believe it has worked out for her. I think she also skips days altogether. I'm sure everyone is different, but it looks like it can work for some.

Yes, I started at 50 mg each day and am down to 12.5 sun mon wed and friday. We have cut a day a week after 4 weeks of a dose. So far they fall the first week and they have then recovered over the next weeks. So far so good. I tried cutting the 25 mg pills to make 12.5 but they just crumple so I have actual 12.5 mg pills. I was at 75000 last week after being at 50000 the week before. Good luck in dosing.

And today I am at 140,000 with no change from my 4 days a week at 12.5mg. Everyone is different, as far as I can tell, however.