Mulpleta is the brand name of Lusutrombopag which is an oral thrombopoietin receptor agonist. It causes an increase in the platelet counts by stimulating and differentiating the megakaryocyte in the bone marrow.

Mulpleta (Lusutrombopag) indications:

• Chronic liver disease-associated thrombocytopenia:

  • It is indicated for the treatment of thrombocytopenia in patients with chronic liver disease who are scheduled to undergo a procedure.

Mulpleta (Lusutrombopag) Dose in Adults:

Note:

It should not be used to normalize platelet counts. Treatment should be initiated 8 - 14 days prior to a scheduled procedure. The procedure should be scheduled 2 - 8 days after the last Lusutrombopag dose. Platelet counts should be monitored before the procedure (not more than 2 days before the procedure).

Mulpleta (Lusutrombopag) Dose in the treatment of Chronic liver disease-associated thrombocytopenia:

• 3 mg orally once a day for 7 days

Missed doses:

• In case a dose is missed, it should be given as soon as possible. The next dose should be given the next day at the recommended time. Doubling the dose is not recommended.

Mulpleta (Lusutrombopag) Dose in Childrens:

It has not been studied in children.

Lusutrombopag (Mulpleta) Pregnancy Risk Category: Not assigned

• Studies on animal reproduction have shown that fetal outcomes can be adverse.

Lusutrombopag use during breastfeeding:

• It is unknown if the drug will be excreted into breastmilk.
• Because of the risk of serious adverse reactions, breastfeeding is not recommended for Lusutrombopag treatments and 28 days following the last dose.

Lusutrombopag (Mulpleta) dose in Kidney disease:

• CrCl ≥30 mL/minute:

  • The manufacturer has not provided any adjustments in the dose in patients with mild to moderate renal impairment.
  • However, mild to moderate renal impairment has little effect on the pharmacokinetics of the drug, and dose adjustment is not necessary.

• CrCl <30 mL/minute:

  • The manufacturer has not provided any adjustments in the dose in these patients as it has not been studied in patients with CrCl of less than 30 ml/minute.

• Hemodialysis:

  • The manufacturer has not provided any adjustments in the dose in these patients as it has not been studied in patients on hemodialysis.
  • Hemodialysis does not enhance its elimination.

Lusutrombopag (Mulpleta) dose in liver disease:

• Mild or moderate hepatic impairment (Child-Pugh class A or B):

  • The manufacturer has not provided any adjustments in the dose in patients with mild to moderate hepatic impairment.
  • However, mild to moderate hepatic impairment has little effect on the pharmacokinetics of the drug, and dose adjustment is not necessary.

• Severe hepatic impairment (Child-Pugh class C):

  • The manufacturer has not provided any adjustments in the dose in patients with severe hepatic impairment.

Side Effects of Lusutrombopag (Mulpleta):

• Central nervous system:

  • Headache

Contraindication to Lusutrombopag (Mulpleta):

There are no contraindications for its use, according to the manufacturer.

Warnings and precautions

• Thromboembolism

  • Like other thrombopoietin agonists, Lusutrombopag is associated with an increased chance of thrombosis.
  • There has never been a significant increase in platelet count after thrombosis.
  • Patients at high risk for thrombosis, such as patients with thrombophilia and those who have a history of thromboembolic events (especially unprovoked thrombosis), should be advised to avoid the drug.
  • Patients with chronic liver disease, including portal vein thrombosis treatment-emergent, have also experienced thrombotic events.
  • Patients with ongoing thrombosis and patients without hepatopetal bloodflow, as well as those with a history of thrombosis should not use Lusutrombopag unless the benefits outweigh the risk.

Monitor:

Monitor platelet counts at baseline and at least 2 days prior to a scheduled procedure. Monitor the clinical features of thromboembolism and adherence to the drug.

How to administer Lusutrombopag (Mulpleta)?

It is administered orally with or without food.

Mechanism of action of Lusutrombopag (Mulpleta):

Lusutrombopag, a thrombopoietin-receptor agonist, activates platelet formation by stimulating the proliferation of megakaryocytes within bone marrow progenitor cell.

The onset of action:

• It takes 12 days (ranging from 5 - 35 days) for the platelet counts to reach the maximum with Lusutrombopag.

Protein binding:

• >99.9%

Metabolism:

• It is metabolized primarily by CYP4 enzymes, including CYP4A11.

Half-life elimination:

• 27 hours

Time to peak serum concentration

• 6 to 8 hours

Excretion:

• Feces: 83% (16% as unchanged drug); Urine: ~1%

International Brands of Lusutrombopag:

• Mulpleta

Lusutrombopag Brand Names in Pakistan:

No Brands Available in Pakistan.