Avatrombopag (Doptelet) has different dosages and precautions for patients with chronic liver disease and chronic immune thrombocytopenic purpura. It is essential to strictly follow the doctor's instructions and use the medication scientifically.
Avatrombopag (Doptelet) Routine Dosage
1. Patients with Chronic Liver Disease
Avatrombopag tablets (Doptelet) should be started 10 to 13 days before the planned surgery. The recommended daily dose should be determined based on the patient's preoperative platelet count:
(1) When the patient's platelet count is below 40 × 10⁹/L, the recommended daily dose is 60 mg (3 tablets) for 5 days;
(2) When the patient's platelet count is between 40 × 10⁹/L and below 50 × 10⁹/L, the recommended daily dose is 40 mg (2 tablets) for the same 5 days. (3) The patient should undergo surgery within 5 to 8 days after taking the last dose of avatrombopag.
(4) Avatrombopag (Doptelet) should be taken orally once daily with food for 5 consecutive days, and the entire 5-day course of treatment must be completed.
2. Adult Patients with Chronic Immune Thrombocytopenic Pulmonary Disease (ITP)
(1) Initial Dose
The initial dose of avatrombopag (Doptelet) is 20 mg (1 tablet) orally daily with food.
(2) Administration
The lowest effective dose of avatrombopag (Doptelet) should be used to achieve and maintain a platelet count ≥50 × 10⁹/L to reduce the risk of bleeding.
Dose adjustments should be determined based on the platelet count response; avatrombopag (Doptelet) should not be used to "normalize" the platelet count.
(3) Platelet Monitoring
After initiating avatrombopag (Doptelet) treatment, platelet counts should be monitored weekly until the platelet count stabilizes at ≥50 × 10⁹/L; thereafter, monthly monitoring is required.
After discontinuing avatrombopag (Doptelet), platelet counts should continue to be monitored weekly for at least 4 weeks.
3. Children aged 6 years and older with persistent/chronic immune thrombocytopenic purpura (ITP)
(1) Initial Dose
The initial dose of avatrombopag (Doptelet) is 20 mg (1 tablet) orally daily with food.
(2) Administration
The lowest effective dose of avatrombopag (Doptelet) should be used to achieve and maintain a platelet count ≥50 × 10⁹/L to reduce the risk of bleeding.
Dosage adjustments should be determined based on platelet count response; avatrombopag (Doptelet) should not be used to "normalize" the platelet count.
(3) Platelet Monitoring
After initiating avatrombopag (Doptelet) treatment, platelet counts should be monitored weekly until the platelet count stabilizes at ≥50×10⁹/L; thereafter, monthly monitoring is required. After discontinuing avatrombopag (Doptelet), weekly platelet count monitoring should continue for at least 4 weeks.
4. Children aged 1 to 6 years with persistent/chronic ITP
(1) The initial dose of avatrombopag powder is 10 mg orally daily (the contents of one capsule), taken with food.
(2) The lowest effective dose of avatrombopag powder should be used to achieve and maintain a platelet count ≥50×10⁹/L to reduce the risk of bleeding. Dosage adjustments must be determined based on platelet count response; avatrombopag powder should not be used to "normalize" the platelet count.
(3) After initiating avatrombopag powder treatment, platelet counts should be monitored weekly until they stabilize at ≥50×10⁹/L; thereafter, monthly monitoring is required. After discontinuing avatrombopag powder, weekly platelet count monitoring should continue for at least 4 weeks.
Avatrombopag (Doptelet) Dosage Instructions
1. Open the capsule and sprinkle the granules into a small amount of soft food or liquid (place in a spoon or cup).
2. Do not swallow the capsule whole, nor chew or crush the granules.
3. Consume the entire contents of the capsule to ensure accurate dosage.
4. Suitable soft foods and liquids to mix with the granules:
(1) Soft foods: apple puree, strawberry jam, (plain) yogurt.
(2) Liquids: Milk (whole or skim), orange juice, (unflavored) children's electrolyte solution, water.
5. Mix the granules with the soft food or liquid (the granules will not dissolve).
6. The mixture should be consumed immediately after preparation and should not be saved for later use.
7. Rinse the spoon or cup with any remaining soft food or liquid and swallow the rinse to ensure the full dose is taken.
Dosage Adjustment of Avatrombopag (Doptelet)
I. Dosage Adjustment for Adult Patients with Chronic Immune Thrombocytopenic Pulmonary Disease (ITP) and Children Aged 6 Years and Older with Persistent/Chronic Immune Thrombocytopenic Pulmonary Disease (ITP)
1. Dosage Adjustment
The dosage adjustment of avatrombopag (Doptelet) tablets should be determined based on the platelet count response, and the daily dose should not exceed 40 mg (2 tablets). The specific adjustment rules are as follows:
(1) If the platelet count remains below 50 × 10⁹/L after at least 2 weeks of taking avatrombopag (Doptelet), the dose level should be increased by one level according to the dose level table. After adjustment, wait 2 weeks before evaluating the effect of the regimen and any subsequent dose adjustments;
(2) If the platelet count is between 200 × 10⁹/L and 400 × 10⁹/L... (2) If the platelet count is higher than 400 × 10⁹/L, discontinue avatrombopag (Doptelet) and increase platelet monitoring frequency to twice a week. When the platelet count is lower than 150 × 10⁹/L, reduce the dose by one level according to the dose grading table and restart treatment.
(3) If the platelet count is higher than 400 × 10⁹/L, discontinue avatrombopag (Doptelet) if the platelet count is still lower than 50 × 10⁹/L after taking 40 mg (2 tablets) of avatrombopag (Doptelet) daily for 4 weeks.
(4) If the platelet count is still lower than 50 × 10⁹/L after taking 20 mg (1 tablet) of avatrombopag (Doptelet) weekly for 2 weeks, discontinue avatrombopag (Doptelet).
2. Dosage Titration Grades of Avatrombopag Tablets
Dose Grade 6: 40 mg (2 tablets) orally daily;
Dose Grade 5: 40 mg (2 tablets) orally three times a week, and 20 mg (1 tablet) orally for the remaining four days;
Dose Grade 4: 20 mg (1 tablet) orally daily (Note: This is the initial dose grade for all patients, except those taking a moderate/strong dual inducer or inhibitor of CYP2C9 and CYP3A4);
Dose Grade 3: 20 mg (1 tablet) orally three times a week;
Dose Grade 2: 20 mg (1 tablet) orally twice a week or 40 mg orally once a week;
Dose Grade 1: 20 mg (1 tablet) orally once a week.
3. Discontinuation of Medication
(1) If, after taking avatrombopag tablets at the maximum dose (40 mg/2 tablets daily) for 4 weeks, the platelet count still does not rise to ≥50 × 10⁹/L, avatrombopag (Doptelet) should be discontinued;
(2) If, after taking 20 mg (1 tablet) of avatrombopag tablets weekly for 2 weeks, the platelet count is still higher than 400 × 10⁹/L, avatrombopag (Doptelet) should be discontinued.
II. Dosage Adjustment for Children Under 1 to 6 Years of Age with Persistent/Chronic ITP
1. Dosage Adjustment
The dosage adjustment of avatrombopag powder should be determined based on the platelet count response, and the daily dose should not exceed 20 mg (the contents of 2 capsules). The specific adjustment rules are as follows:
(1) If the platelet count remains below 50 × 10⁹/L after at least 2 weeks of avatrombopag powder administration, the dose level should be increased by one level according to the dose grading table. After adjustment, wait 2 weeks before reassessing the effectiveness of the regimen and any subsequent dose adjustments;
(2) If the platelet count is between 200 × 10⁹/L and 400 × 10⁹/L, the dose level should be decreased by one level according to the dose grading table. After adjustment... Wait 2 weeks before reassessing the effect;
(3) If the platelet count is higher than 400 × 10⁹/L, discontinue avatrobopa powder and increase platelet monitoring frequency to twice a week. When the platelet count drops below 150 × 10⁹/L, reduce the dose level by one level according to the dose grading table and restart treatment;
(4) If the platelet count remains below 50 × 10⁹/L after taking 20 mg (the contents of 2 capsules) of avatrobopa powder daily for 4 weeks, discontinue avatrobopa powder;
(5) If the platelet count remains above 400 × 10⁹/L after taking 10 mg (the contents of 1 capsule) of avatrobopa powder weekly for 2 weeks, discontinue avatrobopa powder.
2. Dosage Titration Grades of Avatrombopag Powder
(1) Dosage Grade 6: 20 mg orally daily (contents of 2 capsules);
(2) Dosage Grade 5: 20 mg orally three times a week (contents of 2 capsules), and 10 mg orally daily (contents of 1 capsule) for the remaining four days;
(3) Dosage Grade 4: 10 mg orally daily (contents of 1 capsule) (Note: This initial dosage regimen is for all patients except those concurrently taking a moderate/strong dual inducer or inhibitor of CYP2C9 and CYP3A4);
(4) Dosage Grade 3: 10 mg orally three times a week (contents of 1 capsule);
(5) Dosage Grade 2: 10 mg orally twice a week (contents of 1 capsule) or 20 mg orally once a week (contents of 2 capsules);
(6) Dosage Grade 1: 10 mg orally once a week (contents of 1 capsule).
3. Discontinuation of Medication
(1) If, after taking avatrombopag powder at the maximum dose (20 mg/2 capsule contents daily) for 4 weeks, the platelet count still does not reach ≥50 × 10⁹/L, avatrombopag (Doptelet) should be discontinued.
(2) If, after taking 10 mg (1 capsule contents) of avatrombopag powder weekly for 2 weeks, the platelet count still exceeds 400 × 10⁹/L, avatrombopag (Doptelet) should be discontinued.
Management for Missed Doses of Avatrombopag (Doptelet)
If a dose of avatrombopag tablets (Doptelet) or avatrombopag powder is missed, the patient should take it as soon as they remember. Do not take double the dose to make up for the missed dose; the next dose should still be taken at the usual time the following day.
