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Thrombopoietin receptor agonist Pregnancy: There are no available data in pregnant women to inform the drug-associated risk. In animal reproduction studies, oral administration to pregnant rats during organogenesis and the lactation period resulted in adverse developmental outcomes at exposures approximately 89 times the AUC observed in patients at the recommended clinical dose of 3 mg once daily. Advise pregnant women of the potential risk to a fetus (US label section 8.1).

Lusutrombopag

Brand names: Mulpleo

Lusutrombopag is an oral thrombopoietin receptor agonist used to treat severe thrombocytopenia in adults with chronic liver disease who are undergoing a planned invasive procedure.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 3 mg
Route: Oral — with or without food
Frequency: Once daily for 7 days, beginning 8 to 14 days before a scheduled procedure
US label section 2.1: the recommended dosage is 3 mg taken orally once daily with or without food for 7 days. Begin dosing 8-14 days prior to a scheduled procedure, and patients should undergo their procedure 2-8 days after the last dose. MISSED DOSE: take the missed dose as soon as possible on the same day and return to the normal schedule the following day. Lusutrombopag has been investigated only as a single 7-day once-daily dosing regimen in clinical trials in patients with chronic liver disease. It should not be administered to patients with chronic liver disease in an attempt to normalise platelet counts. MONITORING (section 2.2): obtain a platelet count prior to initiation and not more than 2 days before the procedure. PAEDIATRIC: safety and effectiveness in paediatric patients have not been established — verify against a children's formulary. SOURCE: no UK SPC was fetched in this bundle — this draft is distilled from the US prescribing information and must be verified against the UK SPC.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • None stated — the US label section 4 Contraindications reads 'None'

Side effects

  • Headache (the most common adverse reaction, at least 3%)
  • Thrombotic and thromboembolic complications — a labelled warning for thrombopoietin receptor agonists in patients with chronic liver disease
  • Portal vein thrombosis — reported in 1% (2 of 171) of treated patients versus 1% (2 of 170) on placebo in three randomised, double-blind trials, identified post-procedure on protocol-specified imaging and not associated with a marked increase in platelet count

Clinical monograph

How it works

It binds the thrombopoietin receptor on megakaryocyte precursors and stimulates their proliferation and differentiation, increasing platelet production.

Prescribing in practice

  • It increases the risk of thromboembolism, including portal vein thrombosis in patients with chronic liver disease, so assess thrombotic risk before treatment.
  • It is intended for short-term peri-procedural use rather than ongoing management of chronic thrombocytopenia.
  • Treatment should be timed in advance of the procedure in line with the SPC.

Monitoring

Monitor the platelet count before the procedure to confirm an adequate response and remain alert for thrombotic complications.

Counselling the patient

  • This is a short course of tablets taken ahead of your planned procedure.
  • Seek urgent advice if you develop abdominal pain, breathlessness or limb swelling.

Evidence & guidelines

Its use in chronic liver disease before procedures is supported by the L-PLUS phase 3 trial programme.

Reference: NICE TA617; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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